Robotic catheter systems and methods

ABSTRACT

A robotic instrument system having an elongate sheath instrument and an elongate catheter instrument positioned within a working lumen of the sheath instrument is controlled by selectively operating an instrument driver coupled to the catheter instrument to place a control element extending through the catheter instrument in tension, and thereby articulate at least a distal end portion the catheter instrument, while automatically compensating for a torsional force exerted on the sheath instrument in a first direction due to articulation of the distal end portion of the catheter, by urging the sheath instrument to twist in a second direction opposite of the first direction.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit under 35 U.S.C. §119 to U.S.Provisional Application No. 60/920,328, filed Mar. 26, 2007, thecontents of which are incorporated herein by reference as though setforth in full.

The present application may also be related to subject matter disclosedin the following applications and patents, the contents of which arealso incorporated herein by reference as though set forth in full: U.S.patent application Ser. No. 10/923,660, filed Aug. 20, 2004; U.S. patentapplication Ser. No. 10/949,032, filed Sep. 24, 2005; U.S. patentapplication Ser. No. 11/073,363, filed Mar. 4, 2005; U.S. patentapplication Ser. No. 11/173,812, filed Jul. 1, 2005; U.S. patentapplication Ser. No. 11/176,954, filed Jul. 6, 2005; U.S. patentapplication Ser. No. 11/179,007, filed Jul. 6, 2005; U.S. patentapplication Ser. No. 11/185,432, filed Jul. 19, 2005; U.S. patentapplication Ser. No. 11/202,925, filed Aug. 12, 2005; U.S. ProvisionalPatent Application No. 60/750,590, filed Dec. 14, 2005; U.S. ProvisionalPatent Application No. 60/756,136, filed Jan. 3, 2006; U.S. patentapplication Ser. No. 11/331,576, filed Jan. 13, 2006; U.S. ProvisionalPatent Application No. 60/776,065, filed Feb. 22, 2006; U.S. ProvisionalPatent Application No. 60/785,001, filed Mar. 22, 2006; U.S. ProvisionalPatent Application No. 60/788,176, filed Mar. 31, 2006; U.S. patentapplication Ser. No. 11/418,398, filed May 3, 2006; U.S. ProvisionalPatent Application No. 60/801,355, filed May 17, 2006; U.S. ProvisionalPatent Application No. 60/801,546, filed May 17, 2006; U.S. ProvisionalPatent Application No. 60/801,945, filed May 18, 2006; U.S. patentapplication Ser. No. 11/481,433, filed Jul. 3, 2006; U.S. ProvisionalPatent Application No. 60/833,624, filed Jul. 26, 2006; U.S. ProvisionalPatent Application No. 60/835,592, filed Aug. 3, 2006; U.S. ProvisionalPatent Application No. 60/838,075, filed Aug. 15, 2006; U.S. ProvisionalPatent Application No. 60/840,331, filed Aug. 24, 2006; U.S. ProvisionalPatent Application No. 60/843,274, filed Sep. 8, 2006; U.S. ProvisionalPatent Application No. 60/873,901, filed Dec. 8, 2006; U.S. patentapplication Ser. No. 11/637,951, filed Dec. 11, 2006; U.S. patentapplication Ser. No. 11/640,099, filed Dec. 14, 2006; U.S. ProvisionalPatent Application No. 60/879,911, filed Jan. 10, 2007; U.S. ProvisionalPatent Application No. 60/899,048, filed Feb. 1, 2007; U.S. ProvisionalPatent Application No. 60/900,584, filed Feb. 8, 2007; U.S. ProvisionalPatent Application No. 60/902,144, filed Feb. 15, 2007; and U.S. patentapplication Ser. No. 11/678,016, filed Feb. 22, 2007.

FIELD OF THE INVENTION

The invention relates generally to robotically controlled systems, suchas tele-robotic surgical systems, and more particularly, to a roboticcatheter system for performing minimally invasive diagnostic andtherapeutic procedures.

BACKGROUND

Robotic interventional systems and devices are well suited forperforming minimally invasive medical procedures as opposed toconventional techniques wherein the patient's body cavity is open topermit the surgeon's hands access to internal organs. Traditionally,surgery utilizing conventional procedures meant significant pain, longrecovery times, lengthy work absences, and visible scarring. However,advances in technology have lead to significant changes in the field ofmedical surgery such that less invasive surgical procedures, inparticular, minimally invasive surgery (MIS), are increasingly popular.

A “minimally invasive medical procedure” is generally defined as aprocedure that is performed by entering the body through the skin, abody cavity, or an anatomical opening utilizing small incisions ratherthan large, open incisions in the body. Various medical procedures areconsidered to be minimally invasive including, for example, mitral andtricuspid valve procedures, patent formen ovale, atrial septal defectsurgery, colon and rectal surgery, laparoscopic appendectomy,laparoscopic esophagectomy, laparoscopic hysterectomies, carotidangioplasty, vertebroplasty, endoscopic sinus surgery, thoracic surgery,donor nephrectomy, hypodermic injection, air-pressure injection,subdermal implants, endoscopy, percutaneous surgery, laparoscopicsurgery, arthroscopic surgery, cryosurgery, microsurgery, biopsies,videoscope procedures, keyhole surgery, endovascular surgery, coronarycatheterization, permanent spinal and brain electrodes, stereotacticsurgery, and radioactivity-based medical imaging methods. With MIS, itis possible to achieve less operative trauma for the patient, reducedhospitalization time, less pain and scarring, reduced incidence ofcomplications related to surgical trauma, lower costs, and a speedierrecovery.

Special medical equipment may be used to perform MIS procedures.Typically, a surgeon inserts small tubes or ports into a patient anduses endoscopes or laparoscopes having a fiber optic camera, lightsource, or miniaturized surgical instruments. Without a traditionallarge and invasive incision, the surgeon is not able to see directlyinto the patient. Thus, the video camera serves as the surgeon's eyes.The images of the interior of the body are transmitted to an externalvideo monitor to allow a surgeon to analyze the images, make adiagnosis, visually identify internal features, and perform surgicalprocedures based on the images presented on the monitor.

MIS procedures may involve minor surgery as well as more complexoperations that involve robotic and computer technologies, which may beused during more complex surgical procedures and have led to improvedvisual magnification, electromechanical stabilization, and reducednumber of incisions. The integration of robotic technologies withsurgeon skill into surgical robotics enables surgeons to performsurgical procedures in new and more effective ways.

Although MIS techniques have advanced, physical limitations of certaintypes of medical equipment still have shortcomings and can be improved.While known devices may have been used effectively, they may lack therequired or desired degrees of freedom and range of controllable motion.These issues may be particularly relevant in procedures involvingrouting of surgical devices around a number of turns or bends.Consequently, control of a tool or working instrument at the distal tipof an instrument that has traversed a number of curves may be difficultwith known devices, thereby resulting in more complicated and/or lesseffective procedures.

SUMMARY

In accordance with a first aspect of the inventions disclosed herein, arobotic instrument system having an elongate sheath instrument and anelongate catheter instrument positioned within a working lumen of thesheath instrument is controlled by selectively operating an instrumentdriver coupled to the catheter instrument to place a control elementextending through the catheter instrument in tension, and therebyarticulate at least a distal end portion the catheter instrument, whileautomatically compensating for a torsional force exerted on the sheathinstrument in a first direction due to articulation of the distal endportion of the catheter, by urging the sheath instrument to twist in asecond direction opposite of the first direction. Compensating for thetorsional force may be performed when the catheter instrument is bent ina first plane and the sheath instrument is bent in a second planedifferent than the first plane. The sheath instrument may be urged totwist by operating the instrument driver to place a control element ofthe sheath instrument in tension. Additionally, the sheath instrumentmay define a first axis and is bent to define a second axis, and thecatheter instrument is bent to define a third axis, wherein compensatingfor the torsional force is based on: β=K sin(θ)sin(α), whereinβ=compensation of the rotational position of the catheter instrumentwithin the sheath instrument, α=an angle defined between the first axisand the second axis, θ=an angle defined between the second axis and thethird axis, K=a tuning gain factor.

In accordance with a second aspect of the inventions disclosed herein, arobotic instrument system having an elongate flexible sheath instrumentand an elongate flexible catheter instrument positioned within a workinglumen of the sheath instrument has a controller configured to determinea length of a distal end portion of the catheter instrument that extendsbeyond a distal end opening of the sheath instrument, and thenselectively actuate one or more motors in an instrument driver coupledto the respective sheath and catheter instruments to thereby causearticulation of a distal end portion of the catheter instrumentextending through a distal end opening of the sheath instrument, whereinactuation of the motors is based at least in part on the determinedlength so that the resulting articulation of the distal end portion ofthe catheter instrument is scaled.

In one embodiment, articulation of the distal end portion of thecatheter instrument may be scaled based on a filtered curvaturerelationship, KF=a*KC wherein KF=a filtered or adjusted position orcurvature of the catheter instrument, KC=the commanded position orcurvature of the catheter instrument, and “a”=a scaling factor. Also,the scaling factor “a” may be a non-linear function. The non-linearfunction is a function of the length “l” of the catheter instrument thatextends beyond the distal end of the sheath instrument, based on theexpression:

${a(l)} = {1 - \frac{1 - b}{1 + \frac{l^{c}}{d}}}$

wherein “b”, “c”, and “d” are tuning factors for shaping the non-linearfunction.

Further, the scaling may be a minimum for maximum compensation ofarticulation of the catheter instrument when the catheter instrument isfully retracted within the sheath instrument.

In accordance with yet another aspect of the disclosed inventions, arobotic instrument system includes an elongate flexible instrument; acontroller configured to selectively actuate one or more motors operablycoupled to the instrument to thereby selectively move a distal endportion of the instrument within an anatomical workspace in which theinstrument is located; and an imaging device coupled the distal endportion of the instrument and configured to acquire images of tissueregions and structures located within in a field of view, wherein thecontroller is further configured to determine which tissue regions andstructures within the anatomical workspace are locatable within thefield of view of the imaging device based, at least in part, upon apresent relative position of the instrument distal end portion. In oneembodiment, the imaging device comprises an ICE catheter positioned in aworking lumen of the instrument.

In one embodiment, the controller determines a reach of the instrumentdistal end portion and of the field of view of the imaging device withinthe based at least in part on a kinematic model of the instrument.Embodiments of the system may further comprise a display incommunication with the controller, wherein the controller displays thedetermined reach of the field of view of the imaging device on thedisplay, or wherein the controller displays the tissue regions andstructures in the anatomical workspace determined to be within reach ofthe field of view of the imaging device on the display. In one suchembodiment, the controller displays the tissue regions and structures inthe anatomical workspace determined to be within reach of the field ofview of the imaging device overlaying an image of the anatomicworkspace, wherein the image of the anatomic workspace may be obtainedfrom a model of the workspace, from an imaging system, or both.

Other and further embodiments and aspects will be apparent in view ofthe following detailed description read in conjunction with the figures.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the drawings in which like reference numbers representcorresponding parts throughout and in which:

FIG. 1 illustrates a robotic surgical system in which apparatus, systemand method embodiments may be implemented;

FIG. 2 illustrates an example of an operator workstation of the roboticsurgical system shown in FIG. 1 with which a catheter instrument can bemanipulated using different user interfaces and controls;

FIG. 3A illustrates a support assembly or mounting brace for ainstrument driver of a robotic surgical system;

FIG. 3B further illustrates the support assembly illustrated in FIG. 3A;

FIG. 3C is another view of the support assembly shown in FIGS. 3A-B withan attached instrument driver;

FIG. 3D is a perspective view of a support arm adapter base plateassembly configured for attaching a support assembly to an operatingtable or surgical bed;

FIG. 3C further illustrates how the adapter base plate assembly isutilized to attach a support assembly and instrument driver to anoperating table or surgical bed;

FIG. 4 illustrates an instrument driver mounted to a distal segment of asupport assembly;

FIG. 5A illustrates a sheath and guide catheter assembly mounted on aninstrument driver;

FIG. 5B further illustrates the instrument driver shown in FIG. 5Awithout the sheath and guide catheter assembly;

FIG. 5C further illustrates the instrument driver shown in FIG. 5B andone of the mounting plates being moved relative to the mounting platearrangement shown in FIG. 5B;

FIG. 5D is a top view of the instrument driver configured as shown inFIG. 5C;

FIG. 5E is a cross-sectional view of a sheath control assembly;

FIG. 5F illustrates one manner in which a dither assembly that may beused in the robotic surgical system shown in FIG. 1 may be constructed;

FIG. 5G illustrates a brake assembly of the instrument driver shown inFIGS. 4-5D;

FIG. 5H illustrates a funicular assembly of the instrument driver shownin FIGS. 4-5D;

FIG. 5I is another perspective view of the funicular assembly shown inFIG. 5H;

FIG. 5J illustrates a pulley assembly configured to drive a guidecarriage of an instrument driver;

FIG. 5K illustrates a dither motor mount of an instrument driver;

FIG. 6A illustrates a sheath and guide catheter assembly positioned overrespective mounting plates;

FIG. 6B further illustrates how sheath and guide splayers interface withrespective mounting plates;

FIG. 6C is a bottom perspective view of a guide catheter splayer thatmay be mounted to an instrument driver of a robotic surgical system;

FIG. 6D is a top perspective view of the guide catheter splayer shown inFIG. 6C;

FIG. 6E is a perspective view of a sheath instrument mounting plate;

FIG. 6F is a bottom view of the mounting plate shown in FIG. 6E;

FIG. 6G is a perspective view of a torsion spring that can be positionedwithin a pocket or space defined by an interface plate for interfacingwith a mating structure or notch of a splayer cover;

FIG. 6H is a side view of the torsion spring shown in FIG. 6G;

FIG. 6I illustrates an interface plate including a cover applied over atorsion spring;

FIG. 6J shows the cover shown in FIG. 6I removed to show the torsionspring;

FIG. 6K is a perspective view of an example of a guide catheterinterface plate;

FIG. 6L is a top view of the interface plate shown in FIG. 6K;

FIG. 6M is a perspective view of a slidable carriage or funicularassembly of an instrument driver and receiver slots configured toreceive and engage with splayer shafts;

FIG. 6N is a perspective view of a drive shaft positioned for insertioninto a sleeve receptacle located on an instrument driver;

FIG. 6O of a drive shaft that is inserted into a sleeve receptacle;

FIG. 6P is a side view of a drive shaft and associated pulley assemblyand illustrating a flat edge of one side of the drive shaft;

FIG. 6Q is another view of the drive shaft shown in FIG. 6P illustratinga smooth portion of the drive shaft;

FIG. 6R is a perspective view of the drive shaft shown in FIGS. 6P-Qillustrating a flat edge of one side of the drive shaft;

FIG. 6S is a perspective view of a sleeve receptacle or receiver slotconfigured to receive an end of a drive shaft;

FIG. 6T is a side view of the sleeve receptacle shown in FIG. 6S;

FIG. 7A illustrates a sheath and a guide catheter having four controlelements bending upwardly and outwardly from the page in differentdirections in connection with explaining embodiments directed tocompensating for rolling of the guide catheter within the sheath;

FIG. 7B illustrates a sheath bending within the plane defined by thepage and a guide catheter caused to bend in a different direction thanthe sheath but within the same plane by tensioning a pull wire;

FIG. 7C is a cross sectional view into the guide and sheath instrumentsillustrated in FIG. 7B as viewed from a point of reference in FIG. 7B;

FIG. 7D illustrates the assembly of 7B. in which the guide catheter isbent upwardly and outwardly from the page in a direction indicated by acurved arrow to illustrate possible flopping of the guide catheter overinto the anterior or posterior half plane;

FIG. 7E a sheath and guide catheter bending within the same plane asdefined by the page and a pull wire that is actuated to bend the guidecatheter;

FIG. 7F is a cross-sectional view of sheath having an outer surface thatis keyed with an inner surface of a guide catheter instrument;

FIG. 7G illustrates angular relationships between sheath and guidecatheter instruments for use in compensating or correcting for roll ofthe inner guide catheter instrument without the outer sheath instrument;

FIG. 8A is a side view of a sheath instrument deployed with zeroarticulation and different angular configurations of a guide catheterinstrument and the resulting impact on the position of the sheathinstrument in connection with explaining an embodiment directed tocompensating for catheter tip hotness depending on how far the distaltip is extended from the distal end of the sheath instrument;

FIG. 8B illustrates a range of swinging motion of a distal portion of aguide catheter instrument where the point of control is at the verydistal tip of the combined guide catheter structure;

FIG. 8C illustrates the range of swinging action of a distal portion ofa guide catheter instrument where the point of control is at the guidedistal tip rather than at the end of the combined guide structure asshown in FIG. 8B;

FIG. 8D is a graph illustrating variables of a method for compensatingfor catheter tip hotness based on scaling, wherein a scaling factor avaries as a function of a length l of a distal portion of the catheterthat extends outwardly beyond a distal end of the sheath instrument;

FIG. 9A illustrates a distal portion of a guide catheter extendingbeyond a distal end of a sheath instrument by a distance or length L₁and a force F imparted on the distal tip of the guide catheter that maycause the distal portion of the guide catheter to bend or flex;

FIG. 9B illustrates a distal portion of a guide catheter extendingbeyond a distal end of a sheath instrument by a distance or length L₂that is less than the length L₁ shown in FIG. 9A;

FIG. 9C illustrates sheath and catheter components shown in FIGS. 9A-Band a guide catheter control assembly for dithering the guide catheter;

FIG. 9D is a graph illustrating ambient resistive forces as the guidecatheter is dithered in an open space without contacting tissue;

FIG. 9E is a graph illustrating force readings after a time period t1when the guide catheter and the distal tip register only ambientresistive forces and a time period t2 when the distal tip of the guidecatheter contacts tissue;

FIG. 9F illustrates system constructed according to one embodiment thatincludes catheter and sheath control subassemblies for dithering theguide catheter, the distal tip of the guide catheter, and the sheath inunison;

FIG. 9G illustrates a system constructed according to one embodimentthat includes subassembly controllers for dithering or oscillating thedistal tip of a guide catheter laterally;

FIG. 10A illustrates a system for driving a catheter or other instrumentwith a mouse and how a mouse is used to select and move the instrument;

FIG. 10B is a side view representation further illustrating pointsselected by a mouse and trace lines that miss and intersect with thecatheter;

FIG. 11 illustrates assessing reachability and viewability or field ofview according to one embodiment;

FIG. 12A illustrates a depth indication system constructed according toone embodiment that utilizes light or optical energy reflected fromobjects of interest;

FIG. 12B illustrates a depth indication system constructed according toanother embodiment that is based on the size of an image of the objectrelative to a reference or image capturing device and the number ofpixels required to define the object;

FIG. 13A illustrates a stereovision apparatus constructed according toone embodiment that includes a high resolution camera or imaging deviceand a low resolution camera or imaging device;

FIG. 13B illustrates a method of acquiring images from a single camerato form a stereoscopic image according to another embodiment;

FIG. 13C illustrates a stereoscopic camera system constructed accordingto another embodiment that includes endoscopes having high and lowresolution cameras and a lens; and

FIG. 13D illustrates a stereoscopic camera system constructed accordingto another embodiment includes high and low resolution endoscopes and alens.

DETAILED DESCRIPTION OF ILLUSTRATED EMBODIMENTS

Embodiments of the invention generally relate to apparatus, systems andmethods for robotic surgical systems. Robotic surgical system in whichembodiments of the invention may be implemented are described withreference to FIGS. 1-6T. Apparatus, system and method embodiments aredescribed with reference to FIGS. 7A-13D. More particularly, embodimentsdirected to correcting or compensating for rolling or rotation of aguide catheter within a sheath as a result of the torsional complianceof a guide catheter within the sheath are described with reference toFIGS. 7A-G. Embodiments directed to compensating for catheter tip“hotness” variances in the control over the distal portion of thecatheter tip depending on how far the tip extends beyond the distal endof the sheath are described with reference to FIGS. 8A-D. Hotnesscompensation embodiments may involve a model that accounts for rollcompensation, manipulating sheath pull wires to counter torsionalforces, scaling adjustments and/or utilizing a more rigid sheath.Embodiments directed to indicating catheter insertion forces as thecatheter engages tissue or another object are described with referenceto FIGS. 9A-G. Embodiments directed to using a two-dimensional (2D)input device, such as a mouse, for controlling 2-D or three-dimensional(3D) motion, e.g., position and/or orientation, of a guide catheter orother working instrument are described with reference to FIGS. 10A-B.Embodiments directed to determining reachability of catheter instrumentand viewability or fields of view at different reachable locations aredescribed with reference to FIG. 11. Embodiments directed to utilizingan optical light source such as a laser for purposes of performing depthindications or distances between an instrument and an object of interestare described with reference to FIGS. 12A-B. Embodiments related tostereovision utilized by robotic surgical systems are described withreference to FIGS. 13A-D.

Referring to FIG. 1, a robotically controlled surgical system (S) inwhich apparatus, system and method embodiments of the invention may beimplemented includes a robotic catheter assembly (A) having a robotic orfirst or outer steerable complement, otherwise referred to as a sheathinstrument (30) (generally referred to as “sheath” or “sheathinstrument”) and/or a second or inner steerable component, otherwisereferred to as a robotic catheter or guide or catheter instrument (18)(generally referred to as “catheter” or “catheter instrument”). Thesheath instrument (30) and catheter instrument (30) are controllableusing a robotic instrument driver (16) (generally referred to as“instrument driver”). During use, a patient is positioned on anoperating table or surgical bed (22) (generally referred to as“operating table”) to which a robotic catheter assembly (A) is coupledor mounted. In the illustrated example, the system (S) includes anoperator workstation (2), an electronics rack (6) and associated bedsideelectronics box, a setup joint mounting brace (20), and the instrumentdriver (16). A surgeon is seated at the operator workstation (2) and canmonitor the surgical procedure, patient vitals, and control one or morecatheter devices.

Various system (S) components in which embodiments of the invention maybe implemented are illustrated in close proximity to each other in FIG.1, but embodiments may also be implemented in systems (S) in whichcomponents are separated from each other, e.g., located in separaterooms. For example, the instrument driver (16), operating table (22),and bedside electronics box may be located in the surgical area with thepatient, and the operator workstation (2) and the electronics rack (6)may be located outside of the surgical area and behind a shieldedpartition. System (S) components may also communicate with other system(S) components via a network to allow for remote surgical proceduresduring which the surgeon may be located at a different location, e.g.,in a different building or at a different hospital utilizing acommunication link transfers signals between the operator controlstation (2) and the instrument driver (16). System (S) components mayalso be coupled together via a plurality of cables or other suitableconnectors (14) to provide for data communication, or one or morecomponents may be equipped with wireless communication components toreduce or eliminate cables (14). In this manner, a surgeon or otheroperator may control a surgical instrument while being located away fromor remotely from radiation sources, thereby decreasing the operator'sexposure to radiation.

Referring to FIG. 2, one example of an operator workstation (2) that maybe used with the system (S) shown in FIG. 1 includes three displayscreens (4), a touch screen user interface (5), a control button consoleor pendant (8), and a master input device (MID) (12). The MID (12) anddata gloves (13) serve as user interfaces through which the surgeon cancontrol operation of the instrument driver (16) and attachedinstruments. By manipulating the pendant (8) and the MID (12), a surgeonor other operator can cause the instrument driver (16) to remotelycontrol a catheter instrument (18) and/or a sheath instrument (30)mounted thereon. A switch (7) may be provided to disable activity of aninstrument temporarily. The console (9) in the illustrated system (S)may also be configurable to meet individual user preferences. Forexample, in the illustrated example, the pendant (8) and the touchscreen (5) are shown on the left side of the console (9), but they mayalso be relocated to the right side of the console (9). Further,optional keyboard may be connected to the console (9) for inputting userdata. The workstation (2) may also be mounted on a set of casters orwheels to allow easy movement of the workstation (2) from one locationto another, e.g., within the operating room or catheter laboratory.Further aspects of examples of suitable MID (12), data glove (13), andworkstation (2) arrangements are described in further detail in U.S.patent application Ser. No. 11/481,433 and U.S. Provisional PatentApplication No. 60/840,331, the contents of which were previouslyincorporated herein by reference.

Referring to FIGS. 3A-C, a system (S) includes a setup joint or supportassembly (20) (generally referred to as “support assembly”) forsupporting or carrying the instrument driver (16) over the operatingtable (22). One suitable support assembly (20) has an arcuate shape andis configured to position the instrument driver (16) above a patientlying on the table (22). The support assembly (20) may be configured tomovably support the instrument driver (16) and to allow convenientaccess to a desired location relative to the patient. The supportassembly (20) may also be configured to lock the instrument driver (16)into a certain position.

In the illustrated example, the support assembly (20) is mounted to anedge of the operating table (22) such that a catheter and sheathinstruments (18, 30) mounted on the instrument driver (16) can bepositioned for insertion into a patient. The instrument driver (16) iscontrollable to maneuver the catheter and/or sheath instruments (18, 30)within the patient during a surgical procedure. The distal portion ofthe setup joint (20) also includes a control lever (33) for maneuveringthe setup joint (20).

Although the figures illustrate a single guide catheter (18) and sheathassembly (30) mounted on a single instrument driver (16), embodimentsmay be implemented in systems (S) having other configurations. Forexample, embodiments may be implemented in systems (S) that include aplurality of instrument drivers (16) on which a plurality ofcatheter/sheath instruments (18, 30) can be controlled. Further aspectsof a suitable support assembly (20) are described in U.S. patentapplication Ser. No. 11/481,433 and U.S. Provisional Patent ApplicationNo. 60/879,911, the contents of which were previously incorporatedherein by reference.

Referring to FIGS. 3D-E, the support assembly (20) may be mounted to anoperating table (22) using a universal adapter base plate assembly (39),similar to those described in detail in U.S. Provisional PatentApplication No. 60/899,048, incorporated by reference herein in itsentirety. The adapter plate assembly (39) mounts directly to theoperating table (22), and the support assembly (20) can be mounted tothe adapter plate assembly (39). One suitable adapter plate assembly(39) includes a large, flat main plate (39 a) which is positioned on topof the operating table (22). The assembly (39) provides for variousadjustments to allow it to be mounted to different types of operatingtables (22). An edge of the adapter plate assembly (39) may include arail that mimics the construction of a traditional surgical bedrail. Byplacing this rail on the adapter plate (39 a) itself, a user may beassured that the component dimensions provide for proper mounting of thesupport assembly (20). Furthermore, the large, flat surface of the mainplate (39 a) provides stability by distributing the weight of thesupport assembly (20) and instrument driver (16) over an area of thetable (22), whereas a support assembly (20) mounted directly to theoperating table (22) rail may cause its entire load to be placed on alimited and less supportive section of the table (22).

In order to mount the adapter plate assembly (39), table clampassemblies (39 b, 39 c) located on both sides of the adapter plate (39a) are configured to clamp the assembly (39) to the operating table(22). In this example, a single table (22) clamp assembly is used on thesurgeon's side of the table (22) to minimize the amount of spaceconsumed by the adapter plate assembly (39). FIG. 3D illustrates theadapter plate assembly (39) in a first, retracted configuration. Tomount the adapter plate assembly (39), a clamp assembly (39 b) on thesurgeon's side of the table (22) may be removed or extended out of theway and the adapter plate assembly (39) is placed on the top surface ofthe operating table (22). The clamp assembly (39 b) is repositioned andthe bed clamp assemblies (39 b) on the surgeon's side and the clampassemblies (39 c) on the other side are tightened onto the operatingtable rails. The support assembly (20) may then be mounted to theadapter plate rail (39 d) and bedding may be placed over the entireadapter plate assembly (39).

With further reference to FIGS. 4 and 5A-5D, an instrument assembly (A)comprised of a sheath instrument (30) and an associated guide orcatheter instrument (18) is mounted to associated mounting plates (37,38) on a top portion of the instrument driver (16). FIGS. 5B-Dillustrate the instrument driver (16) in further detail with and withoutan attached instrument assembly (A).

During use, the catheter instrument (18) is inserted within a centrallumen of the sheath instrument (30) such that the instruments (18, 30)are arranged in a coaxial manner. Although the instruments (18, 30) arearranged coaxially, movement of each instrument (18, 30) can becontrolled and manipulated independently. For this purpose, motorswithin the instrument driver (16) are controlled such that carriagescoupled to the mounting plates (37, 38) are driven forwards andbackwards on bearings. One or more components, such as the instrumentdriver (16), may also be rotated about a shaft to impart rotationalmotion to the catheter instrument (18) and/or sheath instrument (30). Asa result, the guide catheter instrument (18) and the sheath instrument(30) can be controllably manipulated and inserted into and removed fromthe patient. Additional instrument driver (16) motors may be activatedto control the bending of the guide catheter instrument (18) and thesheath instrument (30), the orientation of the distal tips of theinstruments (18, 30), and any tools mounted at the distal tip of thecatheter instrument (18).

As shown in FIGS. 5C-D, the instrument driver (16) may also include astatus indicator (1051), which may be in the form of a light or LED thatis located on the top face of the instrument driver (16). The indicator(1051) may be used to provide feedback to a user, e.g., via the operatorworkstation (2) as graphical messages on the monitor screens (4) or thetouchscreen user interface (5), indicating whether the instrument driver(16) is properly mounted. For example, in certain systems in which theworkstation (2) is located remotely from the operating table (22), itmay be difficult for an operator installing a catheter assembly (A) ontothe instrument driver (16) to receive status indicator messages withoutrunning back and forth between the workstation (2) and the instrumentdriver (16). Thus, the status indicator (1051) is provided on the topsurface of an instrument driver (16) to provide the user feedback as tothe operational status of the catheter assembly (A). For example, theindicator (1051) may be dark when no catheter assembly (A) has beenmounted onto the instrument driver (16), but when a catheter assembly(A) is mounted onto the catheter interface surfaces (38, 40), the statusindicator (1051) may begin to flash or blink green. This flashing orblinking green light is used to inform the operator that the catheterassembly (A) is being initialized, e.g., by reading a memory devicelocated on the underside of a catheter splayer, pretensioning controlelements such as control wires that extend through one or both of thecatheter and sheath instruments (18, 30), and/or manipulating thecatheter and/or instruments (18, 30) to a known state.

Once the catheter assembly (A) has been recognized and initialized, thestatus indicator (1051) may change to a steady green to indicate thatthe catheter assembly (A) is valid and ready for use. In thisimplementation, the steady green indicator light (1051) may remainilluminated until the catheter assembly (A) is removed or a faultoccurs. The status indicator (1051) may change to a flashing or blinkingamber color when a fault or error condition exists.

For example, if the catheter assembly (A) is invalid (i.e., beingreused, improperly tensioned, etc.), jammed, or improperly installed,the instrument driver (16) and related controls can be configured tocause the indicator light (1051) to flash in an amber color to warn theoperator that a catheter assembly (A) issue needs to be attended to andcorrected. Although the status indicator (1051) is described in thecontext of a steady green value, a flashing green value, and a flashingamber value, other colors, and illumination sequences can be used toprovide different status messages.

FIGS. 5E-K illustrate components of another instrument driver (16) thatmay include components and be configured in a manner similar to theinstrument driver described in U.S. patent application Ser. No.11/481,433, the contents of which were previously incorporated herein byreference. FIG. 5E illustrates a remote control mechanism (RCM) sheathcontrol assembly with its sheath insertion motor and sheath articulationassembly. FIG. 5F illustrates a dither assembly equipped with aplurality of load cell overload protection hard stops to protect theforce sensor load cells. FIG. 5G illustrates aspects of a brake assemblyfor an instrument driver (16). FIGS. 5H-I illustrate a funicularassembly of an instrument driver (16). FIG. 5J illustrates a pulleyassembly for driving a guide carriage of an instrument driver (16). FIG.5K illustrates a dither motor mount (1233).

Referring to FIG. 5E, a remote control mechanism (RCM) sheath controlassembly (50) includes a sheath insertion motor and sheath articulationassembly. In the illustrated embodiment, the sheath insertion motor iscoupled to a drive or output shaft (50 a) that is designed to move thesheath articulation assembly forwards and backwards, thus sliding amounted sheath catheter instrument (18) forwards and backwards also. Thesheath articulation assembly includes a sheath activation motor toprevent proximal bending such that the entire sheath instrument (30) maybend when the distal tip is bending, and a sheath articulation motor tocause the sheath instrument (30) to bend. In one implementation, aspacer is provided to the underside of the articulation assembly toremove any free play that may lower the retaining ring enough to contactthe activation motor during operation.

The output shaft (50 a) may be shorted to eliminate the need for aspacer and to avoid interference between the retaining ring and themotor. The assembly (50) may also include sheath articulation hard stop(50 b), which may be in the form of a modified screw that is configuredto align with a worm gear pin or a dowel pin hard stop (50 b), which maybe useful in the event that vertical misalignment causes two pins towedge together occasionally to cause a fault since a dowel pin hard stopis not sensitive to vertical misalignment.

Referring to FIG. 5F, an instrument driver (16) may include a dithererassembly or mechanism (52) that integrates ditherer mechanics with aforce measurement mechanism (FMM), e.g., similar to that described indetail in U.S. Provisional Patent Application Nos. 60/776,065 and60/801,355, the contents of which were previously incorporated herein byreference. In the illustrated example, the dither assembly (52) includesa linkage/pulley assembly, linear slides, and a guide splayer mountingplate that are mounted directly to the guide catheter carriage. Mountedto the linear slides is a FMM sliding base. The FMM is mounted to thesliding base. The working catheter instrument (18) is free to slide inthe longitudinal direction on the linear bearings. The motion would betowards and away from a guide splayer mounted on the guide interfaceplate (38). As shown in FIG. 5F, a plurality of load cell overloadprotection hard stops (52 a) are provided on both sides of the assembly(52) to advantageously protect force sensor load cells.

Referring to FIG. 5G, the instrument driver (16) may include a brakeassembly (54) that includes twin brake pads (54 a), a square shaft drivehard stop (54 b) that is axially disposed about a shaft (54 d), and asurface (54 c). The portion of the shaft (54 d) proximal to the gear hasbeen machined with the key surface (54 c) for easier alignment of thegear and other parts with the shaft (54 d) during assembly.

Referring to FIGS. 5H-I, an instrument driver (16) may include afunicular assembly (56) that is coupled as part of guide carriage andditherer assemblies. The funicular assembly (56) may include idlers (56a), e.g., anodized aluminum capstan idlers or polycarbonate capstanidlers, which may be useful for limiting cable slippage. Retaining ringsmay be used to capture bearings (56 b) for flanges that receive pulleydrive shafts (61 a) from a catheter splayer (61). The spacing of thelinear bearings of a guide carriage may be increased as necessary toreduce rocking motion as the carriage traverses along its rails to movea mounted guide catheter. Swaged pins (56 c) are used to fasten theupper plate into place, and flanged pins (56 d) are press fitted to theback portion of the funicular assembly (56). A cam (56 e) with balldetents to receive the dither mechanism timing chain is coupled to a pin(56 d) on the assembly.

FIG. 5J illustrates a pulley assembly (57) for driving a guide carriageof an instrument driver (16). In the illustrated example, the pulleyassembly (57) includes flanged plain bearings (57 a) that are includedwith each pulley in the assembly to support side loading and to preventmetal to metal contact, which may wear down parts and cause failures.

Referring to FIG. 5K, a dither motor mount (58) may be configured tohave increased stiffness in sheet metal (58 a) to prevent undesiredflexing of the mount (58). In the illustrated example, a tensioner lockscrew (58 b) is located on an upper portion of the mount and may be usedto adjust the tension of a cable that is used to drive the dithermechanism. A sensor can be soldered into to a cable in a pocket mountand may be a surface mounted PCB that includes a—connector for easyattachment.

Referring to FIGS. 6A-E, an assembly (A) that includes a sheathinstrument (30) and a guide or catheter instrument (18) positioned overtheir respective mounting plates (38, 37). In FIG. 6A, interfacemounting plates (37, 38) are illustrated and other components of theinstrument driver (16) are not illustrated for ease of illustration.

In the illustrated example, a guide catheter instrument member (61 a) iscoaxially interfaced with a sheath instrument member (62 a) by insertingthe guide catheter instrument member (61 a) into a working lumen of thesheath catheter member (62 a). As shown in FIG. 6A, the sheathinstrument (30) and the guide or catheter instrument (18) are coaxiallydisposed for mounting onto the instrument driver (16). However, itshould be understood that a sheath instrument (16) is used without aguide or catheter instrument (18), or a guide or catheter instrument(18) is used without a sheath instrument (30) may be mounted onto theinstrument driver (16) individually. With the coaxial arrangement asshown in FIG. 6A, the guide catheter splayer (61) is located proximallyrelative to, or behind, the sheath splayer (62) such that the guidecatheter member (61 a) can be inserted into and removed from the sheathcatheter member (61 b).

Examples of how sheath and guide sprayers (1050, 1052) may be structuredare shown in FIG. 6B. When a catheter is prepared for use with aninstrument, its splayer is mounted onto its appropriate interface plate.In this case, the sheath splayer (62) is placed onto the sheathinterface plate (38) and the guide splayer (61) is place onto the guideinterface plate (37). The interface plates (37, 38) may be located onthe top surface of the instrument driver (16). In the illustratedexample, each interface plates (37, 38) has four openings (37 a, 38 a)that are designed to receive corresponding D-shaped, stainless steelinsert molds or drive shafts (61 a, 62 a) (generally shaft 61 a)attached to and extending from the pulley assemblies of the splayers(61, 62). In the example illustrated in FIGS. 6B and 6E-F, two shafts(62 a) of the sheath splayer (62) are insertable within the rightapertures or two openings (38 a) of the sheath interface plate (38) asthe splayer (62) is mounted onto the RCM. Similarly, as illustrated inFIGS. 6B and 6K-L four shafts (61 a) of the guide splayer (61) areinsertable within the four apertures or openings (37 a) of the guideinterface plate (37). A pulley lock block in each splayer (61, 62) mayinclude a pair of pogo pins (61 b, 62 b) (generally 61 b) that aredesigned to pass through a pair of openings in the splayer base. In oneembodiment, the pogo pins (61 b) serve as a communication interfacebetween the instrument driver (16) and a memory device that containscatheter characteristics inside the catheter splayer. When the splayer(61, 62) is mounted with respective interface plates (37, 38), pins (61b, 62 b) make contact with their associated interface plate (37, 38),and as an interface plate (37, 38) engages the pins (61 b, 62 b), thepins (61 b, 62 b) are pushed upwardly which, in turn, causes the pulleylock block to move upwardly and compress an internal foam spring.

With further reference to FIGS. 6G-H, a torsion spring (61 c) that isconfigured for insertion within a mounting plate (e.g., as shown inFIGS. 6K-L). One suitable torsion spring (61 c) defines a shape having aheight of about 0.28″ and a width of about 0.50″. FIG. 6I illustratesthe positioning of a torsion spring (61 c) within a mounting plate inwhich spring (61 c) covered by a plate (61 d), and FIG. 6J is the sameview as shown in FIG. 6I except with the plate (61 d) removed to exposethe spring (61 c).

As a splayer is mounted to an instrument driver (16), the releasesurfaces on the opposing sides of the splayer may need to be depressedin order to have the latches to fit through the openings on the mountingsurface. Thus it may be desirable to be able to insert a splayer withoutapplying significant force on the instrument driver (16) to push asplayer down onto its mounting surface of a mounting plate (37, 38).Utilizing torsion springs (61 c) in each mounting surface results in areduction in the amount of downward force that required to insert asplayer since the foam springs located inside of the splayer keep thelatches (61 d, 62 d) (generally 61 d) in a latched position and may nothave to be overcome. The torsion springs (61 c) move out of the way asthe latches (61 d) slide through the openings while a splayer is beingmounted into place. Once the latches (61 d) pass, the springs (61 c)move back into place, and the latches (61 d) are engaged with the bottomsurfaces of the interface plates (37, 38).

The sheath interface mounting plate (38) as illustrated in FIGS. 6E-F issimilar to the guide interface mounting plate (37) as illustrated inFIGS. 6K-L and thus, similar details are not repeated. One differencebetween the plates (37, 38) may be the shape of the plates. For example,the guide interface plate (37) includes a narrow, elongated segment,which may be used with, for example, a dither mechanism. Both plates(37, 38) include a plurality of openings (37 a, 37 b) to receive driveshafts (61 a, 62 b) and latches (61 d, 62 d) from splayers (61, 62),respectively. Referring to FIGS. 6F, 6I, 6J and 6L, undersides (37 b, 38b) of plates (37, 38), respectively, two pockets (37 c, 38 c) arelocated adjacent the notch openings (37 e, 38 e) to hold torsion springs(61 c). As shown in FIG. 6J, the pocket (37 c, 38 c) of this exampleincludes a pattern to help preload and position the spring (61 c) in theright orientation.

During manufacturing, a torsion spring (61 c) may be fitted within eachcavity (37 c, 38 c) as illustrated in FIG. 6J. A cover plate (61 e) isplaced over or screwed into place with nylon screws over the cavity tomaintain the spring (61 c) in place. In the illustrated example, aspring cavity (37 c) overlaps with openings (37 e), thus allowing forthe spring (61 c) to guard part of the opening (37 e). Although thestructural configurations described above may apply to the guide player(61) and the sheath splayer (62), for ease of explanation, reference ismade to the guide splayer (61) and its associated mounting plate (37).

In the illustrated example, latches (61 d), e.g., a pair of latches (61d), are located on the inner surface or underside of the guide splayer(61) (as shown in FIG. 6B). These latches (61 d) are designed to engagewith corresponding notches or openings (38 e) of the plate (37). Whenthe splayer (61) is mounted to the interface plate (37), the latches (61d) are inserted through the notches (61 e) to latch and securely couplethe splayer (61) to the instrument driver (16). As the latches (61 d)slide through the openings (37 e), the latches (1056) engage with thetorsion springs (61 c). The application of downward force in mountingthe splayer (61) causes the springs (61 c) to yield, thus allowing thelatches (1056) to pass and latch onto the bottom of the interface plate(37). The splayer (61) cover and the latches (1056) of this embodimentmay, for example, be ABS molded.

A pair of urethane based compliant members located on the sides of thesplayer (61) cover is over molded with the splayer (61) cover such thatthe splayer (61) cover us formed as a single piece. In the illustratedexample, along opposing sides (61 f) (FIG. 6B) on the inside of thesplayer (61) cover, two pairs of foam pads are located adjacent to alatch (61 d) and serve to provide its latch (61 d) some spring tensionto provide for better engagement between the splayer (61) cover and theinterface plate (37). In one implementation, a user can remove a splayer(61) mounted to an instrument driver (16) by squeezing the compliantmembers at the opposing sides (61 f) which, in turn, depresses anddisengages the latches (61 d) from the notches or openings (37 e) of theinterface plate (37). As the splayer (61) is pulled upwardly, thelatches (61 d) may make contact with the torsion springs (61 c).

Referring to FIG. 6M, another slidable carriage or funicular assembly(56) that may be suitable for instrument driver (16) includes fourreceiver slots (56 f) for receiving and engaging with drive shafts (61a) extending from a catheter splayer (61). Also illustrated in FIG. 6Mis a dither mechanism.

FIGS. 6N-T illustrate shafts (61 a, 62 a) of splayers (61, 62) for usewith instrument driver (16) in further detail. In certain situationsduring a surgical procedure, torque forces may act on a catheterassembly and cause the drive shafts of a splayer to become stuck ordifficult to remove while the torque force is active. The drive shaft(61 a) and associated receiver slots as shown in FIGS. 6N-T facilitateeasier removal of splayers while the catheter is under a torsional load.For example, in some situations, especially during an emergency, it maybe desirable to remove the catheter assembly (18) quickly, but if acatheter assembly (18) is articulated tightly, a strong torque or pullmay be exerted on the catheter control wires and sprayers, therebymaking removal more difficult. In one arrangement, the shafts (61 a) ofa splayer were inserted into receiving sleeves in the instrument driver.The shaft (61 a) configuration shown in FIGS. 6N-T allows such removalto be accomplished more easily compared to standard drive shafts.

More particularly, referring to FIGS. 6N-O, a receiver slot or sleevereceptacle (63 a) extends from the instrument driver (16) and isdesigned to receive the drive shaft (61 a) of a catheter splayer (61).FIG. 6N illustrates a drive shaft (61 a) that is not inserted within thesleeve (63 a), and FIG. 6O illustrates a drive shaft (1054) that isinserted within a sleeve (63 a). The drive shaft (61 a) may also be partof a pulley assembly. 1054) is a part of a pulley assembly (1231) (e.g.,as shown in FIG. 5J).

With further reference to FIGS. 6P-T, illustrate alternate side viewsand a perspective of a drive shaft (61 a) and its pulley assemblycomponent (63 b). In the illustrated example, the drive shaft (61 a) hasa flat edge (63 c) on one side of its cylindrical surface such that whenthe drive shaft (61 a) is viewed along its longitudinal axis, the shafthas the shape of a letter “D”. It should be understood that other adrive shaft (61 a) may include other cross-sectional shapes. The shaft(61 a) has an opening (63 d) through which a cross pin (63 e) may belocated. The drive shaft (61 a) may be keyed such that a socket of theshaft (61 a) is designed to fit or be received within a receiving sleeve(63 a) having a certain shape. The sleeve (63 a) in the illustratedexample includes a pair of V-shaped or wing shaped notches (63 f) toreceive and hold the pin (63 e) of a shaft (61 a) as the shaft (61 a) isinserted into the sleeve (63 a). In the illustrated example, the sleeve(1082) does not employ capture pins, although such pins may be utilized.

During operation of the instrument driver (16), motors coupled to thesleeves (1082) are actuated to rotationally drive the sleeves (63 a). Acatheter assembly (30) with its splayer (61) mounted onto the instrumentdrive (16) would have its shafts (61 a) positioned inside a plurality ofcorresponding sleeves (63 a). As the sleeves (63 a) are rotated, thepins (63 e) of the shafts (61 a) are seated in the V-shaped notches (63f) and are engaged by the rotating sleeves (61 a), thus causing theshafts (61 a) and associated pulley assemblies (63 b) to also rotate.The pulley assemblies (63 b) in turn cause the control elements (e.g.,wires) coupled thereto to manipulate the distal tip of the catheterinstrument (30) member in response thereto. To remove a splayer from theinstrument driver in this implementation, less force is needed as theV-shaped notches (63 f) allow for quick and easy disengagement of theshafts (61 a) from the sleeves (63 a).

Roll Correction

Embodiments directed to systems and methods for compensating orcorrecting for roll or rotational motion or twisting of a non-rigid orflexible catheter instrument (30) positioned within a sheath instrument(18), e.g., as a result of tension applied to control elements or pullwires, are described with reference to FIGS. 7A-G. In one embodiment,embodiments compensate for the torsional compliance of the catheterinstrument (18) or portion thereof, e.g., a portion that is locateddistally relative to a keyed interface between an outer surface of thecatheter (18) and an inner surface of the sheath (30) as a function offorces and torque applied to the catheter (18) and the position of thesheath (30). Embodiments for correcting for catheter (18) roll ortorsional forces may involve compensating for forces on keyedcomponents, or “backlash” compensation, and compensating for forcesbased on the angular arrangements of sheath (30) and catheter (18)components using, for example, a controller, software, hardware or acombination thereof.

More particularly, in a typical system (S), a non-rigid guide catheterinstrument (18) having torsional compliance is coaxially disposed withinthe sheath (30). When the guide catheter instrument (18) issubstantially straight and the sheath instrument (30) is bent orarticulated the guide catheter (18) generally follows the bending actionof the sheath (30) whether towards the anterior, posterior, medial, orlater direction. However, when a sheath (30) is deployed in a bend andfixed in a location in space, and the guide catheter (18) extendingoutwardly from sheath (30) is articulated, the interactions between theguide catheter (18) and the sheath (30) may affect the behavior of thedistal portion of the guide catheter (18) as a result of torsionalforces on the catheter (18) that urge or cause the catheter (18) totwist or rotate. Embodiments advantageously compensate for thesetorsional forces to counter the rolling-type motion of the guidecatheter (18).

Referring to FIG. 7A, a sheath instrument (30) is shown as curving orbending upwardly and outwardly from the page towards the right (71 a),and a guide catheter instrument (18) is shown as curving or bendingupwardly and outwardly from the page, but towards the left (71 b). Inthe illustrated example, the guide catheter instrument (18) includesfour control elements such as pull wires 72 a-d (generally 72). In orderto bend the guide catheter instrument (30) as shown in FIG. 7A, the pullwire (72 a) can be actuated.

By tracing back the path of pull wire (72 a), it can be seen that thepull wire (72 a) is bent and under a tension force, particularly at theinterface (74) at the distal end of the sheath (18) as the sheathinstrument (18) bends into a different plane relative to the guidecatheter instrument (18) and the sheath (30) constrains the guidecatheter (18). Since the pull wire (72 a) is now located at the top ofthe guide catheter instrument (18), inside of the sheath (30), the pullwire (72 a) encounters a certain contact force along that curvature.More specifically, the pull wire (72 a) under tension will attempt tofind a bottom of the resulting curve or bend, thereby generating amoment or twisting or torsional force on the catheter (18), which urgesthe catheter (18) to rotate.

As a result, the proximal section of the guide instrument (18) extendsoutwardly from the sheath instrument (30) and is subjected to torsionalloading. In addition, a greater amount of tension force needs to beexerted at the proximal end of the pull wire (72 a) to ensure that thedesired bend is achieved. Thus, in such a configuration, the commandedposition of the guide catheter instrument (30) may not match the actualposition of the guide catheter instrument (30). In other words, when thesheath instrument (30) and the guide catheter instrument (18) arebending in different planes, the result may be an undesired torquemoment. In some instances, when the guide catheter and sheathinstruments (18, 30) are bending in different planes, the torsionalforces applied to the guide catheter instrument (18) may urge or causethe guide catheter (18) to displace, for example by flopping overundesirably into one of the posterior or anterior half planes, or torotationally displace, or roll, inside the sheath instrument (30), theresults of which is a catheter (18) assuming an actual position that isnot the desired or commanded position.

FIGS. 7B-D further illustrate the bending of sheath (30) and guidecatheter (18) shown in FIG. 7A. In FIG. 7B, the sheath instrument (30)is shown as bending within the plane defined by the page. The guidecatheter instrument (18) is caused to bend in a different direction thanthe sheath instrument (30) within the same plane by tensioning pull wire(72A). Contact forces (73 a) created along the guide catheter instrument(18) on the pull wire (72A) may attempt to shift the sheath instrument(30), especially at proximal portions of the guide catheter instrument(18) located within the sheath instrument (30).

FIG. 7C is a cross sectional view into the guide and sheath instruments(18, 30) as viewed from the point of reference (73 b) of FIG. 7B. Asshown in FIG. 7C, the pull wire (72 b) is illustrated as positioned onthe right hand side of the cross section, and the bend plane is definedas perpendicular into the page. By tensioning pull wire (72 b), theguide catheter instrument (18) may be caused to bend outwardly from thepage plane as defined in FIG. 7B. The direction of bend (73 c) in FIG.7B is upward and towards the left. In the illustrated example, the pullwire (72 a) that is used to bend the guide catheter instrument (18)within the page plane is located along the line of action (73 d) thatextends longitudinally through the center of the guide catheterinstrument (18). The second pull wire (72 a), however, is located abovethe line of action (73 d) in FIG. 7B and results in contact forces (73e) that push the pull wire (72 b) towards the line of action (73 d) todecrease the offset from center. As a result, the guide catheterinstrument (18) may begin to twist and/or roll due to the torsionalforces applied to the catheter instrument (18). FIG. 7D illustrates theassembly shown in FIG. 7B in which the guide catheter instrument (18) isbent upwardly and outwardly from the page in the direction indicated bycurved (73 c). Because the sheath and guide catheter instruments (18,30) bend in different planes in this instance, the guide catheterinstrument (18) may flop over into the anterior or posterior half planeby a certain degree.

However, referring to FIG. 7E, if the sheath and guide catheterinstruments (18, 30) bend in the same plane, then this discrepancy doesnot occur and the guide catheter and sheath instruments (18, 30) bendwithin the same plane as defined by the page. In the illustratedexample, the pull wire (72A) is actuated to bend the guide catheterinstrument (18). Tracing along the length of the pull wire (72A), arrowsindicate the contact forces that exist along the pull wire (72A). Inthis instance, the contact forces along segment of the guide catheterinstrument (18) within the sheath instrument (30) encourage the sheath(30) to bend in that direction.

However, if the guide catheter instrument (18) is actuated to bendoutwardly from the plane, then the line of action is no longer along thecenter line of the guide catheter instrument (18), and the guidecatheter (18) begins to twist and roll as the pull wire (72B) istorqued. Thus, whenever a guide catheter instrument (18) is constrainedby a sheath instrument (18) and its curvature inside the sheath (18) isabove the center, pulling on one of the pull wires (72) of the guidecatheter (18) will cause the guide catheter (18) to twist. This torsionbias condition occurs in the anterior half plane and the posterior halfplane whenever the guide catheter (18) is bending in a different planethan the sheath instrument (30).

One solution for countering or compensating for these torsion forces orbias and urging of the guide catheter instrument (18) to twist is to keythe sheath and guide catheter instruments (18, 30), e.g., as shown inFIG. 7F and described in further detail in U.S. patent application Ser.No. 11/481,433, the contents of which are incorporated by referenceabove. As shown in FIG. 7F, the outer surface of the guide catheterinstrument (18) and the inner surface of a sheath instrument (30) havenon-circular shapes that form a key or shaped interface that is intendedto prevent or reduce rotation of the guide catheter instrument (18)within the sheath (30).

In the example shown in FIG. 7F, the interior of the sheath instrument(30) defines grooves that make contact with keyed portions of the guideinstrument (18). In one implementation, the guide catheter instrument(18) can initially have a circular profile, then become more square asthe control lumens and outer coating are applied during manufacturing.In this implementation, as the guide catheter instrument (18) begins toroll or twist, the keyed interface between the guide catheter instrument(18) exterior and sheath instrument (30) interior will stop the twistingmotion, thereby compensating for any movement or “slop” between thesecomponents. Slop caused by the twisting action may also be activelycompensated by rolling the guide catheter instrument (18) back to thedesired position in some instances.

However, keying between the sheath (30) and the catheter (18) may not beperfect, and issues may arise due to keying misalignments. Similarly,issues may also arise even when the sheath and guide catheterinstruments (18, 30) are correctly aligned and centered, but there istoo much play between the instruments (18, 30). As a result, the guidecatheter instrument (18) may still rotate relative to the sheathinstrument (30) due to torsional forces applied to the catheterinstrument (18).

In one embodiment, the sheath instrument (30) may be designed withsufficient rigidity to maintain its shape and resist these torionalforces. As a result, the sheath (30) will maintain its position andreduce, minimize or eliminate rolling of the catheter instrument (18)within the sheath (30).

In another embodiment, one or more control elements or pull wires of thesheath (30) may be actuated or placed in tension to compensate for thesecontact forces (73 a) such that the distal tip of the catheterinstrument (18) is at or closer to the expected or commanded position.Thus, the undesired slop or motion resulting from torsional complianceof the guide catheter instrument (18) can be compensated by activelyrolling back the guide catheter instrument (18) by manipulating sheathcontrol elements or pull wires. Thus, active compensation can reduceand/or equalize forces on keyed components of the guide catheterinstrument (18) and the sheath instrument (30) such that the guidecatheter (18) does not roll inside of the sheath (18) and will not flopover the posterior and anterior half planes.

Referring to FIG. 7G, another embodiment of compensating for torsionalcompliance of the guide instrument (18) involves adjusting the guideinstrument (18) articulation by generating a compensation output basedon inputs of angular arrangements of the sheath (18) and catheter (30)components, e.g., using controller, hardware, software, or a combinationthereof. As shown in FIG. 7G, the sheath instrument (30) bends towardsthe right hand side within the page plane, and the catheter instrument(18) bends upwardly and outwardly from the page plane. By analyzingfactors such as the desired bend curvature, the bend plane, the desiredposition of the tip of the catheter instrument (18), torsional stiffnessof the catheter instrument (18), and other instrument attributes, theamount of flop or motion that may occur and the amount of rollcorrection that is necessary can be determined.

As discussed above, when the sheath and catheter instruments (18, 30)bend within the same plane, roll correction may not be needed becausethe lines of action are right on center. However, as the guide catheterinstrument (18) bends further and outwardly from the plane such that itapproaches 90° vertically out of the page plane, a maximum amount ofcorrection may be needed. Thus, in one embodiment, the amount of rollcorrection to be applied is a minimum at zero articulation, and amaximum at +/−90° articulation. The amount of compensation may alsodepend on the amount of sheath (18) articulation. More particularly, inone embodiment, if the sheath instrument (18) is straight, then thecurvature of the pull wires of the catheter instrument (30) within thesheath instrument (18) can be zero, and the pull wires are straight.Thus, no contact load is present to cause rolling or twisting of theguide catheter (30).

As shown in FIG. 7G, a first center line or axis (A1) is defined alongthe longitudinal axis of the sheath instrument (30). The sheath (30) isbent to define a second center line or axis (A2). The degree to whichthe sheath (30) is bent is shown as an angle α (74 a) defined betweenthe first and second axes (A1, A2). A third center line or axis (A3) isdefined along the longitudinal axis of the guide catheter instrument(18). An angle θ (74 b) is defined between the second and third centerlines or axes. According to one embodiment, the amount of rollcorrection β of the rotational position of the catheter instrument (18)that is required given the angles α (74 a) and angle θ (74 b) as shownin FIG. 7G is expressed as:

β=K sin(θ)sin(α)

wherein K is a tuning gain factor, θ (74 b) is the angle at which theguide catheter (18) is bent, and α (74 a) is the angle at which thesheath instrument (18) is bent. In one embodiment, the tuning gainfactor K is programmed into a memory device associated with the guidesplayer (61). Other sheath/guide instrument (18, 30) characteristics mayalso be stored to memory, e.g., at the time of manufacture.

Thus, in this embodiment, if the sheath (18) is straight, then the angleα (74 a) is 0° and, and sin (0°) is also zero, resulting in no rollcorrection. However, if the sheath (18) bends at an angle α (74 a) of90°, then sin (90°) is one, and the amount the roll correction dependson the degree of bending of the guide catheter instrument (30).

With regard to the degree of bending of the guide catheter instrument(30), as long as the guide catheter (30) is within the same bend planeas the sheath (18), then the angle θ (74 b) remains zero, and sin (0°)is zero, resulting in no correction even though the sheath (18) is fullyarticulated. However, as the guide catheter (30) begins to bendoutwardly from the bend plane of the sheath (18), the angle θ (74 b)increases until it is a maximum 90°. When the sheath (18) is articulatedto 90° and the guide catheter (30) is articulated to 90° out of thesheath (18) bend plane, the roll correction factor β is a maximum value.

Thus, embodiments directed to roll correction advantageously allow therotational position and direction of the guide instrument (30) to becontrollably adjusted, whereas conventional systems and methods lacksuch controls, possibly leading to the guide catheter instrumentflopping over as it bends. Embodiments of heuristic roll correction canbe implemented in system software so that the compensation isautomatically calculated by the system during system operation and canbe used to supplement guide catheter (30) control. In one embodiment,the angle of sheath (18) articulation, the angle of guide (30)articulation, and the relevant bend planes are monitored.

In another embodiment, roll correction can be implemented by directlycalculating the exact control forces present at the distal portion ofthe guide catheter (30) based on the bend curvature and the amount offorce that is necessary to compensate for those control forces. Onemanner in which this embodiment may be implemented is by numericallysolving differential equations. While this alternative approach may notbe ideal as a real time solution, it may be useful for offlineactivities such as planning of the surgical procedure beforehand andbuilding a map of accessible areas of the anatomy.

Further, while embodiments are described with reference to rollcorrection or compensation for sheath and guide catheter instruments(18, 30) having a keyed interface, embodiments can also be applied tonon-keyed instruments (18, 30), e.g., when using a catheter instrument(18) having greater torsional stiffness.

Catheter Tip Hotness Compensation

Referring to FIG. 8A, another embodiment is generally directed tosystems and methods for compensating for catheter (18) tip hotness, orthe degree to which the actual curvature or position of the distalportion or tip of the flexible catheter (18) deviates from an expectedor commanded curvature or position as a result the coupling or forcesbetween the catheter (18) and a flexible guide catheter (18), which varydepending on the length of the distal portion of the catheter (18) thatextends beyond the distal end of the sheath instrument (30). Embodimentsadvantageously address these inconsistencies by compensating the amountof articulation depending on the extension of the distal end of theguide catheter (18) beyond the distal end of the sheath instrument (30).In one embodiment, the compensation (reduction in articulation) isgreater when the coupling between the sheath instrument (30) and thecatheter instrument (18) is the greatest, e.g., when the catheterinstrument (18) is retracted into the sheath instrument (30) or extendsfrom the sheath instrument (30) by a small amount. Compensation(reduction in articulation) is less or at a minimum (if any) ininstances involving the least coupling between the sheath instrument(30) and the catheter instrument (18), e.g., when the catheterinstrument (18) is fully extended from the sheath instrument (30).

FIG. 8A illustrates a sheath instrument (30) deployed with zeroarticulation and a guide catheter instrument (18) that is locatedcoaxially within the sheath (30). A distal portion of the guide catheterinstrument (18) extends and articulates outwardly from the distal tip ofthe sheath instrument (30). The sheath instrument (18) can be consideredto be a rigid structure that constrains the proximal portion of theguide catheter instrument (30). However, during actual use, this modelor assumption may not accurately reflect the manner in which the guidecatheter (30) bends or is manipulated due to forces imparted on thesheath (18) by the guide catheter (30) which, in turn, cause the sheath(18) to bend undesirably, thereby changing the curvature or position ofthe catheter instrument (18). The degree to which the catheterinstrument (30) causes this unintentional bending of the sheathinstrument (18) is referred to as the “hotness” of the distal tip of thecatheter instrument (30). The distal tip is “hotter” when it causes moredeviation or bending of the sheath (18).

This “hotness” effect may be more pronounced when the guide (18) isalmost fully retracted into the sheath (30), and less pronounced whenthe guide catheter (18) is substantially or fully extended from thesheath (30), in which case the degree of coupling between the guidecatheter (18) and the sheath (30) is less than when the guide catheter(18) does not extend from the sheath (30), or does so by a small amount.In other words, when the catheter instrument (18) is retracted into thesheath (30), for example, forces upon and motion of the catheter (18)have a larger impact on and coupling with the sheath (30) and sheath(30) position, resulting in a “hotter” distal tip of the catheter (18)since it has more of an impact on the distal end of the sheath (30).

Thus, when the guide catheter (18) is fully retracted or is almost fullyretracted, relatively small motions of the master input device (MID)(12) used to control the catheter instrument (18) may result in largeswings of curvature at the distal tip of the sheath (30) becausecurvature is related to the amount of force seen at the distal tip. Thedistal tip of the sheath (18) may swing back and forth in response tothese large forces. This effect may be more pronounced if a tipextension (83) is added to the distal tip of the guide catheter (18) orwhen a working catheter is deployed out the guide (18) distal tip.

With embodiments, the “hotness” of the distal tip of the catheter (18)can be compensated using a mechanics model, manipulation of sheath pullwires, scaling, and using more rigid sheath materials. In oneembodiment, a mechanics model of the sheath (30) is used to determinehow forces on the sheath (30) should be adjusted, e.g., by manipulatinga pull wire of the sheath (30). In another embodiment, a hybridmechanics model of the sheath (30) and guide catheter (18) may be usedto determine how forces on the sheath (30) and/or guide catheter (18)should be adjusted. An example of a suitable mechanics model for use inembodiments is described in U.S. Utility patent application Ser. No.12/022,987, filed Jan. 30, 2008, which is incorporated by reference inits entirety herein. In another embodiment, one or more control elementsor pull wires of a sheath instrument (30) can be manipulated to counterthe forces that are coupled to the sheath (30) by the catheter (18) whenthe distal tip of the catheter (18) does not extend beyond the distalend of the sheath (30) or extends beyond the distal end of the sheath(30) by a small amount, e.g., by less than about one to about twoinches. Thus, if a sheath (30) is pulled to the left, a pull wire of theright side of the sheath (30) can be placed in tension to urge or movethe sheath (30) back to the right to assume its original or intendedposition.

However, with this embodiment, full actuation of the sheath instrument(18) may not be possible due to, for example, the sheath (18) havinglimitations related to the pullwire configuration in a particularscenario. For example, the sheath (18) shown in FIG. 8A is illustratedas including a first pull wire (81 a) that terminates at a firstlocation within the sheath (18) and a second pull wire (81 b) thatterminates at a second, distal point, e.g., at the distal tip of thesheath (18) as illustrated. In the illustrated example, if the guidecatheter instrument (18) articulates to the right (82 a), the distal tipof sheath (30) is caused to follow the guide catheter (30) and alsoflexes to the right. With the arrangement of sheath pull wires (81 a-b)in this example, the control wires (81 a-b) may not be able to correctthis flexing action. However, if the guide catheter (18) articulates tothe left (82 b), the distal tip of the sheath (30) is caused to flex tothe left. In this instance, the distal pull wire (81 b) may be actuatedto straighten the sheath (18) distal tip and to compensate for thisflexing motion. In both cases, the undesired flexing action of thesheath (30) is increased as the guide catheter (30) is articulated to agreater degree. Thus, the movement of the distal tip of the sheath (30)may also be more pronounced when a working catheter is deployed out theguide catheter (18).

As shown in FIG. 8A, the point of control (84) for the guide catheter(30) is defined at the distal tip of the guide catheter (30), as opposedto at the distal tip of the extension (83). As shown in FIG. 8B, thepoint of control (84) is at the distal tip of the combined structure ofthe guide catheter (18) and the extension (83), i.e., at the distal tipof the extension (83). FIG. 8B illustrates the range of swinging motionof a guide catheter (18) when the point of control (84) is at the distaltip of the combined guide catheter (18) structure. In this example, ifthe MID (12) is moved slightly back and forth, the distal tip of thecombined structure including the guide catheter (30) and the extension(83) may swing back and forth in between a region of space defined bylines (85).

FIG. 8C illustrates the range of swinging action for a guide catheter(18) where the point of control (84) is at the distal tip of the guidecatheter (30) (e.g., as shown in FIG. 8A), rather than at the distal tipof the combined structure (as shown in FIG. 8B). When the MID (12) ismoved for this configuration, the point of control (84) still swingsback and forth to the limits defined by lines (85) like the embodimentshown in FIG. 8B, except that because the stiff tip extension (1220)extends beyond the distal tip of the guide catheter (30), that length isnot accounted for and may undesirably protrude beyond the expected rangeof motion, thereby resulting in an unintended, wider swing. As a result,the operator may observe a larger amount of swinging motion thanexpected depending on what extends distally beyond the point of controland by what length. One embodiment compensates for these effects byutilizing a sheath (30) that includes control wires for compensating forflexing and swinging actions.

In another embodiment, the guide catheter (30) controls may be adjustedsuch that the point of control (84) is at the distal tip of the combinedcatheter assembly structure (including 30, 83) as described withreference to FIG. 8B. This embodiment may involve an understanding ofthe inverse kinematics and solving the mathematics relating to a stifftip extension or working catheter. In one embodiment, a model is createdto simulate the dynamics of the guide catheter (30) and to allow for themodular addition of tip portions of varying lengths.

A further embodiment is directed to a method for compensating for thehotness of the distal tip of the guide catheter (18) by scaling down theamount of commanded catheter (18) movement based on how far the guidecatheter (18) is retracted into the sheath (30). In one embodiment, thescaling factor is applied primarily when the guide catheter (18) isfully or substantially retracted within the sheath (30), i.e., itextends from the sheath (30) by a small amount. According to oneembodiment, the filtered or compensated curvature K_(F) for the guidecatheter (18) instrument can be defined as:

K _(F) =a*K _(C)

where K_(C) is the commanded, filtered or adjusted curvature and “a” isa scaling factor. According to one embodiment, the scaling factor “a” isa non-linear function that is based on the insert length “l’, i.e., thelength of the guide catheter (18) that extends beyond the distal tip ofthe sheath (30) as illustrated in FIG. 8A. In one embodiment, thescaling function a(l) is expressed as:

${a(l)} = {1 - \frac{1 - b}{1 + \frac{l^{c}}{d}}}$

wherein “b”, “c”, and “d” are tuning factors for shaping the curve ofthe non-linear function. In one embodiment, b=0 to represent a zeroscale for zero insert, exponent c=3 to represent how fast to ramp up thescaling as the insert length increases, and gain or application factord=2000 to represent a ratio of scaled growth.

FIG. 8D illustrates the scaling factor a varying as a function of lengthl of the distal part of the guide catheter (30) that extends beyond thedistal tip of the sheath (18) in one embodiment. In the illustratedexample, when the insert length l is zero, a(0) is a small non-zeroamount. Thus, when the length l is small, the commanded articulationK_(C) is reduced to K_(F), but as the length l increases, i.e., theguide catheter (18) is extended further beyond the distal end of thesheath (30), then the ratio approaches one, indicating that thecommanded curvature K_(C) is fully driven or articulated (i.e.,compensated to a lesser degree). This example also illustrates that thescaling factor a increases rapidly as the guide catheter (30) isextended from the sheath (18) until a predetermined length, at whichpoint the commanded articulation does not need to be scaled down orcompensated.

In yet another embodiment, the stiffness of the sheath (30) can beactively adjusted such that the stiffness of the sheath (30) changesdepending on the extension of the distal tip of the guide catheterinstrument (18) beyond the distal tip of the sheath (30). Thus, thesheath (30) is actively controlled to be stiffer when the distal tip ofthe catheter (18) does not extend beyond the distal end of the sheath(30) or extends beyond the distal end of the sheath (30) by a smallamount, e.g., by less than about one to about two inches, and less stiffwhen the catheter (18) is extended by a larger degree, e.g., more thanabout two inches, or fully extended.

Insertion Force Indicator

Referring to FIGS. 9A-G, a further embodiment is directed systems andmethods for indicating catheter (30) insertion forces. When the guidecatheter (30) extends from the sheath (18) and makes contact withtissue, a certain force F is imparted onto the guide catheter (30).Depending on how far the distal tip (92) of the guide catheter (30) isextended from the sheath (18), the force F may result in differentinteractions between the guide catheter (18) and tissue.

More particularly, FIG. 9A shows a length L₁ of the guide catheterinstrument (18) that extends beyond the distal tip (91) of the sheath(18). As the distal tip (92) of the guide catheter (18) makes contactwith tissue with a force F, an equal and opposite force F is imparted tothe guide catheter instrument (18) (represented by arrow F). Dependingupon the magnitude of the force F, a portion of the guide catheter (18),e.g., adjacent to the distal tip (92), may be caused to bend, flex orbuckle under the force F, thereby reducing the force exerted on thetissue.

FIG. 9B illustrates a guide catheter (18) that extends a shorter lengthL₂ beyond the distal tip (91) of the sheath (30). In this example, whenthe distal tip (92) of the guide catheter (18) makes contact with tissuewith the same force F, the shorter length L2 reduces or eliminatesflexing since the distal portion of the guide catheter (18) isreinforced by the distal end of the stiffer sheath (30), resulting in alarger force F that is applied to the tissue due to less flexing.

In one system (S), motors of the instrument driver (16) are controlledto robotically control and manipulate catheter instruments (18). Theamount of current supplied to the motor is proportionally related to theamount of torque generated by the motors and catheter (18) insertionforce is proportional to the motor torque. Thus, the motor current isproportional to the insertion force. If the motors are driven by thesame amount of current regardless of how far the guide catheter (18)extends out from the sheath (30), the force imparted on the tissue atthe contact point may differ based on length L. For example, if a highmotor current causes a high insertion force for a guide catheter (30)extending length L₁, the catheter (30) may dissipate a portion of thatforce due to flexing or bending. However, when the guide catheter (30)extends a much smaller length L₂, it may not yield, and the insertionforce is not attenuated. In one embodiment, a kinematic model of theinstrument configuration may be utilized, in concert with sensed motortorques at driveshafts within the instrument driver, to calculate, or“back out”, the loads and vectors thereof that are theoretically appliedto the distal end of the instrument, or other portion of the instrumentin contact with an external load-applying structure.

In one embodiment, a system (S) may be configured to generate a visualor audible warning message to a user, control element or processorindicating that corrective action is required and/or to indicate apossibility of high insertion forces exerted to tissue at the distal tip(92). In one embodiment, a warning message is displayed when length L isless than a minimum length L_(min) and/or the motor current I is greaterthan I_(max). For example, the minimum length L_(min) may be about 30 mmor less, and the maximum motor current I_(max) may be about 250 mA orhigher current levels. In cases in which the length or motor currentexceeds these pre-determined values, the operator may adjust the motorcurrent accordingly or proceed carefully to avoid causing injury. Thistype of force indication message may be useful for instrument driver(16) that do not have force sensing capabilities.

One manner in which insertion or contact forces may be determined is bydithering the guide catheter (18). The guide catheter (18) may bedithered independently from the sheath (30). As illustrated in FIG. 9C,one manner in which dithering may be implemented is by use of adithering system that includes a control subassembly (94) that isassociated with the guide catheter (18). The subassembly (94) orcomponents thereof are cycled or oscillated forwards and backwards toimpart a dithering motion to the guide catheter (18).

FIG. 9D is a graph that illustrates ambient resistive forces as theguide catheter (18) is dithered in an open space without contactingtissue. These ambient resistive forces may be due to friction betweenthe guide catheter (18) and the sheath (30). Ambient resistive forcesmay also be due to friction between the guide catheter (18) and fluid(e.g., blood, etc.) in the cavity where the guide catheter (18) isapplied. FIG. 9E is a graph that illustrates force readings after a timeperiod t1 when the guide catheter (18) and the distal tip (92)registered only ambient resistive forces, and after a time period t2when the distal tip (92) contacts tissue. As shown in FIG. 9E, peakforce readings at t2 are higher than peak force readings at t1.

In this example, the actual tissue contact force may be determined bysubtracting the force readings acquired at t2 from the force readingsacquired at t1. In another embodiment, as illustrated in FIG. 9F, theguide catheter (18), sheath (30), and distal tip (92) may be controlledto dither in unison by cycling or oscillating the catheter controlsubassembly (94) and a sheath control subassembly (95) together.

Referring to FIG. 9G, in another embodiment, the distal tip (92) may becontrolled to dither or oscillate laterally, and lateral contact forcesmay be determined in a manner similar to that described above. In thisembodiment, the distal tip (92) may be oscillated laterally byoscillating the guide catheter (18) by tensioning various combinationsof guide catheter control elements or pull wires (72 a-d) at the guidecontrol subassembly (94) and associated controllers (94 a-d). Similarly,the distal tip (92) may be oscillated laterally by oscillating thesheath (30) by tensioning various combinations of sheath cathetercontrol elements or pull wires (e.g., one or more of four pull wires 81a-d) at the sheath control subassembly (95) and associated controllers(95 a-d).

Mouse Instinctive Driving

As described above, a primary three-dimensional (3D) input device forthe robotic catheter systems (S) is the master input device (MID) (12).According to another embodiment, a two-dimensional (2D) input device ismanipulated by an operator within a 2D plane for instinctive driving ofa catheter instrument (18) or other working instrument within a limitedrange of motion within a two dimensional plane which, e.g., may beselected by a camera, or within a 3D space. In one embodiment, the twodimensional input device is manipulated to control the position of thecatheter instrument (18). In a further embodiment, the two dimensionalinput device is manipulated to control an orientation of a catheterinstrument (18). According to another embodiment, the two dimensionalinput device is manipulated to control the position and the orientationof a catheter instrument (18).

In one embodiment, the two dimensional input device is a mouse that isoperably coupled to one or more controllers or processors of the system(S) shown in FIG. 1. Mouse components are well known and are notdescribed in further detail. In one embodiment, an operator canmanipulate the mouse such that movement of the mouse in a twodimensional plane results in movement of a catheter instrument (18) in athree dimensional space using appropriate software, hardware and/orcontrol elements. While a mouse may not provide for the same degree ofmotion that can be achieved using a MID (12), use of a mouseadvantageously allows for minute adjustments if it is desirable tomaintain the position of the catheter instrument (18) within aparticular plane in space, e.g., in embodiments in which 2D mouse motionis translated into 2D catheter instrument (18) motion.

In one embodiment the mouse can be used to select a tool or instrumentto be driven. The selection mechanism of one embodiment comprisescreating a ray trace between a selected point and the current mouseposition. An object intersecting the ray trace in a two dimensionalregion bound by the camera viewport is determined to be the selectedobject to be manipulated.

More particularly, referring to FIG. 10A, a display (102), such as acomputer monitor, display a three dimensional object, such as a catheter(18). The catheter (18) may be displayed within or relative to a threedimensional space, such as a body cavity or organ, e.g., a chamber of apatient's heart. An operator uses the mouse to move a control pointaround the display (102) and clicks the mouse at a point (or clicks apoint or position) on the display (102) as indicated by point (104 a).Utilizing appropriate software and/or hardware, a trace line isprojected into the three dimensional space of the body cavity. In theillustrated example, the trace line of point (104 a) fails to interactor intersect with the catheter (18).

As shown in FIG. 10A, the operator selects or clicks another point onthe display (102), such as point (104 b). In this example, the projector trace line of point (104 b) interacts or intersects the catheter (18)at a point near the distal portion of catheter (18). FIG. 110Billustrates a side view representation illustrating point (104 a) andwhere the trace line of point (104 a) “misses” the catheter (18).Further illustrated in FIG. 10B, the trace line projected from point(104 b) interacts or intersects with the catheter (18) near the distalportion of the catheter (18). Once the computer software recognizes thatthe trace line intersects with the catheter (18), e.g., based on laserreflections, ultrasound reflections, etc.), movement of the catheter(18) can now be made by a mouse or other 2D input control device that isoperably coupled to the system (S), such as a trackball, light pen, etc.In embodiments in which movement is within a two dimensional plane, theplane of motion may be selected using a camera.

The mouse may now control the x-y movements of the catheter (18) at theinteraction or intersection point of the catheter (18) by simpletranslation movements of the mouse. In addition, the operator may use akeyboard and the mouse to define rotational movements of the catheter(18) at the interaction or intersection point of the catheter (18).Thus, three dimensional movement of an object is advantageously achievedby substantially two dimensional movements or commands from a mouse oranother known two dimensional input device. Although embodiments aredescribed with reference to a mouse, in other embodiments, the twodimensional input devices may be a trackball and a light pen or othersuitable two dimensional input device.

Reachability/Viewability

Another alternative embodiment is directed to methods and systems forassessing reachability and viewability at a particular location. Moreparticularly, embodiments advantageously assess locations within thebody that can be reached by a catheter instrument (18) of the system(S), as well as assessing the viewability or field of view at aparticular location that can be reached by the catheter instrument (18).This ability is particularly significant since the field of view at aparticular location may not be desirable even if it is reachable. Thus,embodiments advantageously assess field of view at reachable locationsin order to provide more meaningful surgical planning and results.

For example, in the context of cardiac surgery utilizing an intracardiac(ICE) catheter. During the planning stage, an operator can determineoffline before a procedure where a catheter should be driven to providefor a desired field of view that allows a region of interest to bescanned. Alternatively, a previously acquired CT model may be registeredand fused with real time ultrasound data during a surgical procedure.During use, embodiments allow the ICE catheter to be driven to aposition within the heart with a desired or optimum field of view forscanning of, e.g., the left atrium, or another internal tissue orsegment thereof that is of interest.

Referring to FIG. 11, in one embodiment, a robotic medical systemincludes an outer sheath 100 with a working lumen, and an inner guidecatheter 111 extending through the sheath lumen, with a distal endportion of the guide catheter 111 extending out a distal end opening ofthe sheath 110 in an anatomic workspace 116 in a body. An intracardiac(ICE) ultrasound imaging catheter 112 is positioned in a working lumenof the guide catheter 111, with a distal end portion of the ICE catheter112 extending out a distal end opening of the guide catheter 111. TheICE catheter 112 may be extended out of, and retracted into,respectively, the distal end opening in the guide catheter 111, asindicated by arrow 115A, and may be rotated about its longitudinal axis,as indicated by arrow 115B, such that a transducer array 113 on the ICEcatheter 113 is positionable within the anatomic workspace 116 tocapture ultrasound images within a field of view 114 of the array 113.The depicted ICE catheter 112 comprises a substantially linear array 113defining a field of view 114 having a substantially trapezoidal shape;ICE catheters with such configurations are available from suppliers suchas the Ultrasound division of Siemens AG under the tradename AcuNav™. Inother embodiments, substantially circular/disc shaped fields of view maybe created utilizing an ultrasound transducer configuration which may berotated along with a portion of the ICE catheter with a drive shaft, asin the ICE catheters available from Boston Scientific, or utilizingmultiple ultrasound transducers placed circumferentially around acatheter body, as in the ultrasound imaging catheters available fromVolcano Corporation. For illustrative purposes, FIG. 11 depicts a lineararray, AcuNav™ type configuration—but each of the aforementioned otherconfigurations may be similarly employed.

Depending on factors such as the anatomical boundaries and tissuestructures in the anatomical workspace 116, and the relative positionsand prior trajectories of the sheath 110, guide catheter 111, and ICEcatheter 112 within the workspace 116, the system controller (not shownin FIG. 11) can model the potential relative movement the respectivesheath 110, guide 111 and ICE catheter 112, and thus the potentialmovement of the field of view 114 of the transducer array 113 within thework space 116. In particular, certain tissue walls and/or structureswithin the anatomic workspace 116 can be readily imaged (or “viewable”)by the ICE transducer 113 without requiring anything more than arelatively simple repositioning of the respective sheath 110, guide 111and ICE catheter 112, respectively, such as tissue structure 117 in FIG.11. Other tissue wall locations and/or structures may be viewable, butonly by more complicated maneuvering techniques, including iterativemovements of one or more of the sheath 110, guide 111 and/or ICEcatheter 112, respectively, in order to position the transducer 113 andfield of view 114, such as tissue structure 118 in FIG. 11. Stillfurther tissue wall locations and/or structures may be difficult orimpossible to capture within the field of view 114 of the ICE transducer113 without a major repositioning of the collective instruments (sheath110, guide 111, ICE catheter 112), if at all.

This “ICE viewability” analysis may be useful for both pre-operativeplanning, and during a procedure, wherein the robotic system controlleris configured to determine a respective reach of the distal end portionof the ICE catheter 112, and thus the potential fields of view 114 thatmay be captured by the transducer array 113 within the anatomicalworkspace 116, based at least in part upon a planned or a presentrelative position of the respective sheath, guide and ICE catheter 112instruments. By way of non-limiting examples, the controller maydetermine the viewability of the various anatomic wall surfaces and/ortissue structures based at least in part on a kinematic model of one orboth of the sheath and guide catheter instruments 110 and 111. Further,the controller may display the possible field of views, viewable tissuewalls and/or structures, or both, overlaying an image of the anatomicworkspace on a display associated with the robotic system, wherein theimage of the anatomic workspace is obtained from a model of theworkspace, from an imaging system, or both.

By way of further non-limiting example, the viewability of the tissuewalls and structures may be displayed in a manner that indicates whichareas of the workspace may be viewed by the transducer array 113 of theICE catheter 112 from its present position (e.g., by rotating the ICEcatheter 113 about its longitudinal axis, as indicated by arrow 115B inFIG. 11), and which areas cannot be viewed by the transducer array 113from the present position of the ICE catheter 112. Further, theviewability of the various tissue walls and structures within theworkspace 116, and/or the fields of view of the transducer 114, may bedisplayed as a scaled gradation, e.g., including a first location zonehighlighted on the display to indicate that it can be viewed by thetransducer 113 from the present position of the ICE catheter 112, or bysimple maneuvering, a second location zone highlighted on the display toindicate it may possibly be captured within the field of view 114 of thetransducer 113 by using additional or special maneuvering of the ICEcatheter 112, and a third location zone may be highlighted on thedisplay to indicate that it cannot be viewed/imaged by the transducerarray 113 from its present position without more fundamental orcomplicated repositioning of the respective sheath/guide and or ICEcatheter instruments.

In some embodiments, in determining the viewability of the varioustissue wall regions and/or structures the controller determines andcauses to be displayed a relative ease or difficulty in viewing/imagingrespective locations and structures in the workspace 116. The controllermay also may take account a likelihood that some portion of therespective instruments 110/111/112 may get hung up into tissue or someother structure in the workspace 116 an attempted move from theirrespective present positions to other potential locations and positionsin the anatomical workspace. By way of example, if a collision isrequired for the distal end portion of the ICE catheter 112 to reach aparticular position or range of positions within the anatomicalworkspace 116 in order to provide a particular field of view 114 for thetransducer array 113 when moved from its present position, the locationof each such position may be highlighted or otherwise designated on thedisplay. In one embodiment, in determining the reach of the transducerarray on the distal end of the ICE catheter 112, the controller takesinto account one or more of locations of sensitive tissue structures inthe workspace to be avoided, locations of target tissue structures inthe workspace to be reached, planned trajectories of the respectivesheath, guide and ICE catheter instrument distal ends, and planned endpositioned of the respective instruments.

The system of claim 32, wherein the reach of the instrument distal endportion is displayed as a scaled gradation, including at least a firstlocation zone highlighted on the display to indicate that a collision isnot required for the instrument distal end portion to reach a particularposition therein when moved from its present position, a second locationzone highlighted on the display to indicate that at least a portion ofthe instrument would collide with or deflect an adjacent tissuestructure in order for the instrument distal end portion to reach aparticular position therein when moved from its present position, and athird location zone highlighted on the display to indicate that itcannot be reached by the instrument distal end portion from its presentposition.

In one embodiment, the viewability of the tissue wall regions and/orstructures in the workspace 116 are displayed as a “yes”(viewable/imagable) or “no” (not viewable/imagable), or as a numeric orother scaled gradation. In another embodiment, the controller determinesand causes to be displayed a relative imaging quality of images obtainedfrom the respective fields of view for capturing the respective tissuewall surface and/or tissue structures in the workspace 116.

Depth Indicator

A further embodiment is directed to methods and systems that utilize anoptical light source, such as a laser, an infrared or light source, thatprojects outwardly from a distal tip of a catheter (18) or other tool todetermine the distance between the light source and an object ofinterest or tissue wall. Embodiments are particularly useful inapplications in which it is desirable to have a camera, but the limitedspace that is provided limits the number and sizes of cameras that maybe utilized. For example, the space that is available for camera deviceis quite limited in endo-urological surgeries and diagnoses involvingthe bladder, kidneys, and lungs. In these instances, all that may beavailable is a monocular vision device since the limited space does notallow for a stereo camera system. As a result, it can be difficult todetermine the scale of an object. Embodiments, however, advantageouslyenable a surgeon to determine the size of objects utilizing a small,optical device that is operable without significant movement.

For example, in one embodiment, a light beam is projectedperpendicularly out the distal tip of a catheter (18) or a tool onto anarea of interest. By determining the takeoff point of that and directionof that first beam, in combination with the shining of additional beamsto the same area of interest, one may be able to triangulate on thedepth field and to calculate the distance to the area based on how apartthe shone light beams appear on the surface.

More particularly, referring to FIG. 12A, a depth indicator systemconstructed according to one embodiment includes an optical or lightsource (121) that directs optical energy or light towards a first objectof interest (122 a) and a second object of interest (122 b). Lightemitted by the light source (121) is reflected from the objects ofinterest (122 a, 122 b) and the reflected light (122 c) is captured ordetected by a sensor (123). Based on the geometry of the light path fromthe light source (121) to the objects of interest (122 a, 122 b), thereflected light (122 c) paths from the first and second objects (122 a,122 b) to the sensor (123), the distance between the light source (121)and the first object of interest (122 a), and the distance between thelight source (121) and the second object of interest (122 b) may bedetermined based on the known positions of the light source (121) andthe sensor (123). According to one embodiment, the optical or lightsource (121) is a laser. In a further embodiment, the source (121) is aninfrared source that emits infrared energy, and the sensor is configuredto detect reflected infrared energy.

Referring to FIG. 12B, in a system constructed according to anotherembodiment, actual sizes of objects of interest may be determined basedon the number of pixels that define the object of interest and thedistance or depth of the object from a reference point (125) (e.g., animage capturing device). For example, an object of known size may becalibrated at various depths or distances. As illustrated in FIG. 12B,an object (122) that is positioned directly in front of the imagecapturing device (125) will appear very large, as indicated by theheight of the image (124 a). However, if the object (122) is positionedfarther away, e.g., at a distance d1 relative to the image capturingdevice (125), then the resulting image (124 b) is smaller. Similarly, asthe object (122) is positioned even farther away, e.g., at a distance d2from the image capturing device (125), then the resulting image (124 c)is even smaller. Moreover, if the object (122) is positioned evenfarther away from the image capturing device (125), then the resultingimage (125 d) is even smaller.

Accordingly, as the image (124) becomes smaller, the number of pixelsrequired to define the object (122) is also smaller. Therefore, bydetermining the depth or distance of an object (122) relative to areference point (125), and measuring the number of pixels required todefine the image (124) of the object (122), the actual size of theobject (122) can be determined based on the calibrated information. Assuch, although an object (122) may appear to be the same size on adisplay as provided by an image capturing device (125), the actual sizeof the object (122) may differ due to the depths or distances of theobject (122) from the image capturing device (125). Embodimentsadvantageously utilize this structural configuration and opticalrelationships to enable use of small cameras in limited spaces to assessdistances and sizes of objects or tissue of interest, e.g. as part of adiagnosis or treatment of kidney stones, the bladder, the lungs andother organs and tissues in which limited space may be available.

Stereovision

According to a further alternative embodiment, systems and methods aredirected to implementing stereovision utilizing two cameras in ageometrically-efficient configuration particularly useful in situationsin which the physical space for cameras and instruments in general islimited.

Referring to FIG. 13A, in one embodiment, a stereovision apparatusconstructed according to one embodiment includes two cameras (131 a, 131b). The first camera 131 a may a relatively high quality camera, e.g.having a resolution of about 64×480 pixels, and the second camera 131 bis advantageously a lower quality camera having a lower resolution, e.g.about 16×120 pixels, which may be configured to consume less space thancamera configured to capture higher-resolution images. According to oneembodiment, the cameras (131 a, 131 b) are attached to or components ofrespective endoscopes or other elongate instruments. Thus, embodimentsare structured in contrast to known devices that use two high qualitycameras or two cameras having substantially similar and highresolutions.

With the embodiment shown in FIG. 13A, the first and second cameras (131a, 131 b) are used to acquire a stereoscopic image of the object 122.However, embodiments that utilize a first, higher resolution camera inconcert with a second, lower resolution camera are still able to providebenefits of stereoscopy while reducing the size or profile of theoverall apparatus and reducing the costs of the stereoscopic imaginginstrument configuration.

One manner in which the system shown in FIG. 13A may be utilized is toacquire images with both cameras (131 a, 131 b), and then merge or fusethe acquired images together to form a stereoscopic image, which islower quality compared to a typical stereoscopic image acquired with twohigh quality cameras. For this purpose, according to one embodiment,images acquired by the lower quality camera (131 b) may be intentionallyundersampled, and images acquired by the higher quality camera (131 a)may be acquired at a normal rate. Thus, embodiments provide astereoscopic image and depth information in applications which, forexample, would otherwise be suitable for only a single camera andprovide a monocular image that does not provide depth information sinceembodiments are able to generate a stereoscopic image (albeit a lowerquality stereoscopic image) while reducing the size of components of thesystem used for this purpose.

Referring to FIG. 13B, in another embodiment, stereoscopic images may beacquired by using a single camera (131) to capture images from more thanone position, and time multiplexing the resulting images to gainbenefits of stereoscopy for an image set captured over a window of time.That is, as illustrated in FIG. 13B, one camera (131) is multiplexed ina short period of time over different locations or positions (P1, P2,P3) over time, thereby capturing images of the object 1202 fromdifferent positions. The images acquired at different times at differentlocations may then be fused or merged together to form a stereoscopicimage of the object (122).

In another embodiment, a two-camera stereoscopic system may includecomponents that are combined together. As illustrated in FIG. 13C, astereoscopic camera system may include endoscopes (133 a, 133 b) thatinclude respective high resolution and low resolution cameras (131 a,131 b), and an image capturing objective or lens (132). Referring toFIG. 13D, a stereoscopic camera system constructed according to anotherembodiment includes a high resolution scope (134 a), a low resolutionscope (134 b), and an objective or lens (132). In other words, in oneembodiment, to achieve the aforementioned functional benefits of havingone high-resolution image capture device and one low-resolution imagecapture device, and also to utilize the geometric and cost efficienciesof having a single image capture device, such as a charge coupled device(“CCD”) chip, a majority of the pixels of a CCD chip may be directed andlensed for capturing images from one perspective, while a minority ofthe pixels of the same CCD chip may be directed and lensed for capturingimages from another perspective; the lenses may comprises a singleconstruct overlaid upon the CCD chip; thus a single CCD chip may beutilized to provide benefits of stereoscopy in a very cost and geometryefficient package.

While various embodiments haven been described herein, such disclosureis provided for purposes explanation and illustration. Further, variousembodiments may be used in combination with other embodiments.Additionally, although certain embodiments are described with referenceto particular dimensions or parameters, it should be understood thatthese dimensions and parameters are provided for purposes ofexplanation, and that other dimensions and parameters may also beutilized.

Embodiments and instruments of robotic systems (S) may be used invarious minimally invasive surgical procedures that involve differenttypes of tissue including heart, bladder and lung tissue, for example.Depending on the procedure, distal portions of various instruments maynot be easily visible to the naked eye. Various imaging modalitiesincluding magnetic resonance (MR), ultrasound, computer tomography (CT),X-ray, fluoroscopy, etc. may used for this purpose to visualize thesurgical procedure and location of instruments. Further, it may bedesirable to know the precise location of a given catheter instrumentand/or working tool at any given moment to avoid undesirable contacts ormovements. For this purpose, one or more localization techniques thatare presently available may be applied to any of the apparatuses andmethods disclosed above. For example, one or more localization coils maybe built into a flexible catheter instrument. In other implementations,a localization technique using radio-opaque markers may be used withembodiments of the present invention. Similarly, a fiber optic Braggsensing fiber may be built into the sidewall of a catheter instrument tosense position and temperature. Embodiments may also be implemented insystems that include a plurality of sensors, including those for sensingpatient vitals, temperature, pressure, fluid flow, force, etc., may becombined with the various embodiments of flexible catheters and distalorientation platforms disclosed herein.

Embodiments of flexible catheters and other related instruments used ina robotic surgical system may be made of various materials, includingmaterials and associated techniques that are the same as or similar tothose described in U.S. patent application Ser. No. 11/176,598, thecontents of which were previously incorporated by reference. Forexample, suitable materials may include stainless steel, copper,aluminum, nickel-titanium alloy (Nitinol), Flexinol® (available fromToki of Japan), titanium, platinum, iridium, tungsten, nickel-chromium,silver, gold, and combinations thereof, may be used to manufacture partssuch as control elements, control cables, spine elements, gears, plates,ball units, wires, springs, electrodes, thermocouples, etc. Similarly,non-metallic materials including, but not limited to, polypropylene,polyurethane (Pebax®), nylon, polyethylene, polycarbonate, Delrin®,polyester, Kevlar®, carbon, ceramic, silicone, Kapton® polyimide,Teflon® coating, polytetrafluoroethylene (PTFE), plastic (non-porous orporous), latex, polymer, etc. may be used to make the various parts of acatheter and other system components.

Further, although embodiments are describe with reference to a catheterin the form of a guide catheter and working instruments, it is alsocontemplated that one or more lumens of catheters may be used to deliverfluids such as saline, water, carbon dioxide, nitrogen, helium, forexample, in a gaseous or liquid state, to the distal tip. Furthermore,it is contemplated that some embodiments may be implemented with a openloop or closed loop cooling system wherein a fluid is passed through oneor more lumens in the sidewall of the catheter instrument to cool thecatheter or a tool at the distal tip.

Further, although various embodiments are described with reference to asheath and/or a guide catheter having four control elements or pullwires, it may be desirable to have a guide instrument with differentnumbers of control elements, e.g., less than four control elements.Further, although certain embodiments are described with reference to aguide catheter in combination with a steerable sheath, other embodimentsmay be implemented in systems that include a guide catheter (or othercatheter) in combination with a prebent, unsteerable sheath, or perhapswith no sheath at all. Further, embodiments described above may beutilized with manually or robotically steerable instruments, such asthose described in U.S. patent application Ser. No. 11/481,433,previously incorporated herein by reference. The instrument driver canbe configured and adapted to meet the needs of different system andinstrument configurations, e.g., using different numbers of motors andgearboxes for driving control elements, or variation in theconfiguration for actuating a given control element interface assembly,and associated variation in the tensioning mechanism and number ofcontrol element pulleys associated with the pertinent control elementinterface assembly (one pulley and one cable per control elementinterface assembly, two pulleys and two cables per control elementinterface assembly, slotted, split carriage, and winged split carriageembodiments, various tensioning embodiments, etc).

Accordingly, embodiments are intended to cover alternatives,modifications, and equivalents that fall within the scope of the claims.

1. A method of controlling a robotic instrument system, the systemcomprising an elongate sheath instrument and an elongate catheterinstrument positioned within a working lumen of the sheath instrument,the method comprising: operating an instrument driver coupled to thecatheter instrument to place a control element extending through thecatheter instrument in tension, and thereby articulate at least a distalend portion the catheter instrument; and automatically compensating fora torsional force exerted on the sheath instrument in a first directiondue to articulation of the distal end portion of the catheter, by urgingthe sheath instrument to twist in a second direction opposite of thefirst direction.
 2. The method of claim 1, wherein the sheath instrumentis urged to twist by operating the instrument driver to place a controlelement of the sheath instrument in tension.
 3. The method of claim 1,wherein compensating for the torsional force is performed when thecatheter instrument is bent in a first plane and the sheath instrumentis bent in a second plane different than the first plane.
 4. The methodof claim 3, wherein the sheath instrument defines a first axis and isbent to define a second axis, and the catheter instrument is bent todefine a third axis, wherein compensating for the torsional force isbased on:β=K sin(θ)sin(α) wherein β=compensation of the rotational position ofthe catheter instrument within the sheath instrument, α=an angle definedbetween the first axis and the second axis, θ=an angle defined betweenthe second axis and the third axis, K=a tuning gain factor.
 5. Arobotically controlled medical instrument system, comprising: acontroller; an instrument driver operatively coupled to the controller;a sheath instrument operatively coupled to the instrument driver; and acatheter instrument operatively coupled to the instrument driver,wherein the catheter instrument is positioned in a working lumen of thesheath instrument, the catheter instrument having a control elementextending there through for controllably articulating a distal endportion of the catheter instrument, wherein placing the control elementin tension places a torsional force on the sheath instrument that urgesthe sheath instrument to twist in a first direction, and wherein thecontroller is configured to automatically compensate for the torsionalforce exerted on the sheath instrument by urging the sheath instrumentto twist in a second direction opposite of the first direction throughselected operation of the instrument driver.
 6. The system of claim 5,wherein the sheath instrument defines a first axis and is bent to definea second axis, and the catheter instrument is bent to define a thirdaxis, wherein the controller is configured to compensate for thetorsional force based on the relationship:β=K sin(θ)sin(α) wherein β=compensation of the rotational position ofthe catheter instrument within the sheath instrument, α=an angle definedbetween the first axis and the second axis, θ=an angle defined betweenthe second axis and the third axis, K=a tuning gain factor.
 7. A methodof controlling a robotic instrument system, the system comprising anelongate flexible sheath instrument and an elongate flexible catheterinstrument positioned within a working lumen of the sheath instrument,the method comprising: determining a length of a distal end portion ofthe catheter instrument that extends beyond a distal end opening of thesheath instrument; and selectively actuating one or more motors in aninstrument driver to thereby cause articulation of a distal end portionof the catheter instrument extending through a distal end opening of thesheath instrument, wherein actuation of the motors is based at least inpart on the determined length so that the resulting articulation of thedistal end portion of the catheter instrument is scaled.
 8. The methodof claim 7, wherein articulation of the distal end portion of thecatheter instrument is scaled based on a filtered curvaturerelationship,K _(F) =a*K _(C) wherein K_(F)=a filtered or adjusted position orcurvature of the catheter instrument, K_(C)=the commanded position orcurvature of the catheter instrument, and “a”=a scaling factor.
 9. Themethod of claim 8, wherein the scaling factor “a” is a non-linearfunction.
 10. The method of claim 8, wherein the non-linear function isa function of the length “l’ of the catheter instrument that extendsbeyond the distal end of the sheath instrument, based on the expression:${a(l)} = {1 - \frac{1 - b}{1 + \frac{l^{c}}{d}}}$ wherein “b”, “c”,and “d” are tuning factors for shaping the non-linear function.
 11. Themethod of claim 8, wherein the scaling is a minimum for maximumcompensation of articulation of the catheter instrument when thecatheter instrument is fully retracted within the sheath instrument. 12.A robotic instrument system, comprising: an elongate flexibleinstrument; a controller configured to selectively actuate one or moremotors operably coupled to the instrument to thereby selectively move adistal end portion of the instrument within an anatomical workspace inwhich the instrument is located; and an imaging device coupled thedistal end portion of the instrument and configured to acquire images oftissue regions and structures located within in a field of view, whereinthe controller is further configured to determine which tissue regionsand structures within the anatomical workspace are locatable within thefield of view of the imaging device based, at least in part, upon apresent relative position of the instrument distal end portion.
 13. Thesystem of claim 12, wherein the controller determines a reach of theinstrument distal end portion and of the field of view of the imagingdevice within the based at least in part on a kinematic model of theinstrument.
 14. The system of claim 12, further comprising a display incommunication with the controller, wherein the controller displays thedetermined reach of the field of view of the imaging device on thedisplay.
 15. The system of claim 12, further comprising a display incommunication with the controller, wherein the controller displays thetissue regions and structures in the anatomical workspace determined tobe within reach of the field of view of the imaging device on thedisplay.
 16. The system of claim 15, wherein the controller displays thetissue regions and structures in the anatomical workspace determined tobe within reach of the field of view of the imaging device overlaying animage of the anatomic workspace.
 17. The system of claim 16, wherein theimage of the anatomic workspace is obtained from a model of theworkspace, from an imaging system, or both.
 18. The system of claim 12,wherein the imaging device comprises an ICE catheter positioned in aworking lumen of the instrument.
 19. The system of claim 12, wherein thetissue regions and structures in the anatomical workspace determined tobe within reach of the field of view of the imaging device reach of theinstrument distal end portion is displayed in a manner that indicateswhich tissue regions and structures of the workspace may be capturedwithin the field of view of the imaging device from its presentposition, and which tissue regions and structures of the workspace maynot be captured within the field of view of the imaging device from itspresent position.
 20. The system of claim 12, wherein the tissue regionsand structures in the anatomical workspace determined to be within reachof the field of view of the imaging device are displayed as a scaledgradation, including at least a first location zone highlighted on thedisplay to indicate the tissue regions and structures that can becaptured within the field of view of the imaging device from its presentposition by normal maneuvering of the instrument, a second location zonehighlighted on the display to indicate the tissue regions and structuresthat can be captured within the field of view of the imaging device fromits present position by using with additional or special maneuvering ofthe instrument, and a third location zone highlighted on the display toindicate the tissue regions and structures that cannot be capturedwithin the field of view of the imaging device from its present positionregardless of maneuvering of the instrument.
 21. The system of claim 12,wherein the reach of the imaging device field of view is displayed as a“yes” or “no”, or as a numeric or other scaled gradation.
 22. The systemof claim 12, wherein in determining the reach of the imaging devicefield of view, the controller determines and causes to be displayed arelative ease or difficulty in reaching respective locations andpositions in the workspace.
 23. The system of claim 23, wherein indetermining the reach of the imaging device field of view, thecontroller takes into account one or more of locations of sensitivetissue structures in the workspace to be avoided, locations of targettissue structures in the workspace to be reached, planned trajectoriesof the instrument distal end portion, and planned end points of theinstrument distal end portion and of the imaging device.